DOI: 10.1111/jsr.

13181

ABSTRACT

E S R S 2 02 0
O r a l Sessions

O R A L S E SS I O N 1 – S LE E P D I SO R D ER E D Results: Two hundred and forty-­seven (47%) had subjective symptoms

B R E ATH I N G A N D C A R D I OVA S CU L A R of insomnia with a median BIS of 21 (IQR 16, 27). 145 had COMISA with
DISEASE a median BIS of 21 (IQR 16, 27). Mean age was 50.1 (SD 10.4) in those
with insomnia and 52.8 (SD 9.1) in those with COMISA. Individuals with
insomnia were more likely to be older than those without. No difference
O01 | Subclinical myocardial injury in co-­ was found in sex, age, smoking, hypertension, total cholesterol or GFR
between those with COMISA or OSA. cTnI was measured in 288 (141
morbid insomnia and sleep apnoea (COMISA):
with COMISA) and cTnT in 285 (140 with COMISA). There was no dif-
data from the Akershus Sleep Apnoea study
ference in the median of either cTnI (p = 0.84) or cTnT (p = 0.19) between
individuals with insomnia. There was no difference in median of cTnI
F.D. Sigurdardottir1,2; M.N. Lyngbakken1,2; H. Hrubos-
(p = 0.83) or cTnI (p = 0.41) between OSA and COMISA and no differ-
Strøm3,4; G. Einvik5; H. Røsjø1,6; T. Omland2
1
ence in multivariate analysis for cTnI (adjusted B −0.2 [95% CI −0.18,
Cardiovascular Research Group, University of Oslo/Institute of Clinical
0.15]) or cTnT (adjusted B 0.09 [95% CI −0.05, 0.23]).
Medicine, Oslo; 2Department of Cardiology, Akershus University
Conclusions: Neither subjective insomnia or COMISA was associ-
Hospital, Lørenskog; 3Department of Behavioural Sciences, University
ated with an increased subclinical myocardial injury compared with
of Oslo/Institute of Basic Medical Sciences, Oslo; 4Division of
OSA alone.
Surgery, Department of Ear Nose and Throat Surgery; 5Department
Disclosure: Nothing to disclose.
of Pulmonology; 6Division of Research and Innovation, Akershus
University Hospital, Lørenskog, Norway

O02 | FACE: phenotyping analysis of

Objectives/Introduction: Co-­
morbid insomnia and sleep apnoea
(COMISA) is prevalent in approximately 39–58% of individuals with
obstructive sleep apnoea (OSA) and has been associated with greater
sleep impairment. Cardiac troponin I (cTnI) and cardiac troponin T (cTnT)
are sensitive and specific markers of subclinical myocardial injury and
are associated with increased severity of OSA. The aim of this study
was to investigate whether insomnia or COMISA was associated with
increased subclinical myocardial injury compared to OSA alone.
Methods: cTnI was measured with a high-­sensitivity (hs) assay on
the prototype ARCHITECT STAT (Abbott Diagnostics) and cTnT
was measured with an hs-­assay on a cobas e411 platform (Roche
Diagnostics) in 535 participants of the Akershus Sleep Apnoea
study. Participants underwent in-­hospital polysomnography (PSG)
and categorized according to standardized criteria as having no OSA
(AHI <5) or OSA (AHI 3
5). Subjective symptoms of insomnia were
assessed with the Bergen insomnia scale (BIS). Wilcoxon rank-­sum
test was used to compare the median cTnI and cTnT between groups.
Linear regression analysis was performed with adjustments for sex,
age, smoking, hypertension, cholesterol and GFR.
chronic heart failure (CHF) patients with sleep
disordered breathing (SDB) indicated for adaptive
servoventilation (ASV): 2-­year follow-­up results
R. Tamisier1; T. Damy2; J.-M. Davy3; J. Verbraecken4; S.
Bailly1; F. Lavergne5; A. Palot6; F. Goutorbe7; J.-L. Pépin1;
M.-P. d'Ortho8; FACE Investigators
1
HP2, Grenoble Alpes University Hospital, Grenoble; 2Service de
Cardiologie, AP-­HP, Hôpital Henri Mondor, Créteil; 3Cardiology Unit,
University Hospital Montpellier, Montpellier, France; 4Multidisciplinary
Sleep Disorders Center, Antwerps University Hospital, Antwerps,
Belgium; 5ResMed Science Center, Saint-­Priest; 6Pneumology Unit,
Saint Joseph Hospital, Marseille; 7Sleep Center, Bezier Hospital,
Beziers; 8Département de Physiologie-­EFR, AP-­HP, Hôpital Bichat,
Paris, France
Objectives/Introduction: FACE collected real life clinical data and
long-­term follow-­up (FU) in a CHF population with SDB eligible for

J Sleep Res. 2020;29(Suppl. S1):e13181. |

wileyonlinelibrary.com/journal/jsr  © 2020 The Authors Journal of Sleep Research     1 of 356
https://doi.org/10.1111/jsr.13181 © 2020 European Sleep Research Society
 |
2 of 356       ABSTRACTS
ASV. We previously identified 6 clinically meaningful clusters using
Latent class analysis. We investigate herein whether these may have
different morbi-­mortality.
Methods: Reduced (HFrEF), middle range (HFmrEF) and preserved
(HFpEF) CHF classes were included. Eligible SDB were central sleep
apnea (CSA), coexistent obstructive central SA not controlled under
CPAP and CPAP emergent CSA. ASV was offered to all. Controls
were patients who refused ASV at inclusion. Morbi-­mortality events
were collected for 2 years. Primary endpoint in the time-­to event
analysis was the first event of death, unplanned hospitalization for
worsening HF or cardiac transplant.
Results: 503 patients were included in the ITT analysis at 2-­year
FU. ASV was protective for primary outcome (univariate cox model
HR = 1.67 [1.12; 2.49], p = 0.01). Cluster behavior regarding primary
outcome was different, the worst prognosis was for HFrEF with CSA
(log rank test, p = 0.04). ASV did not benefit in the HFrEF with CSA
or OSA clusters (log rank test, p = 0.79) but was protective for 2
clusters: obese HFpEF with CSA (log rank test, p = 0.005) and severe
hypoxemic patients with OSA (log rank test, p = 0.03).
Conclusions: These results align with recent studies that showed no
impact on morbi-­mortality of ASV in HFrEF but a protective effect
in two HFpEF clusters.
Disclosure: Study funded by ResMed.
O03 | Long-­term mortality of patients after
acute myocardial infarction with reduced (<45%)
left ventricular ejection fraction and moderate to
severe sleep apnea
O. Ludka1,2,3; R. Stepanova1,3; T. Kara4; J. Spinar2,3
1
Cardiovascular Sleep Research Laboratory, International Clinical
Research Center, St. Anne's University Hospital; 2Department of
3
Internal Medicine and Cardiology, University Hospital Brno; Medical
Faculty, Masaryk University, Brno, Czech Republic; 4Division of
Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic
and Foundation, Rochester, MN, United States
Objectives/Introduction: Sleep apnea (SA) has a high prevalence
in patients after myocardial infarction (MI). While SA might be a
modifiable risk factor, recent data suggest that SA is severely un-
derdiagnosed in patients after MI. There is a limited evidence about
long-­term prognosis of patients with moderate to severe sleep apnea
with reduced left ventricular ejection fraction (REF) after MI.
Methods: We prospectively studied 782 consecutive patients ad-
mitted to the hospital with the diagnosis of acute MI. The study was
conducted in two tertiary care institutions, where primary percu-
taneous coronary intervention (PCI) is the standard of care in the
treatment of acute MI. All subjects underwent sleep evaluations
using a portable diagnostic device after at least 48 h post-­admission,
provided they were in stable condition. Patients were followed for
median follow-­up of 44 months.
Results: Almost all patients (98%) underwent urgent coronary angiogra-
phy and 91% of patients underwent primary PCI. Technically inadequate
limited sleep studies (less than 4 h recording time or inability to score
study due to excessive artifact) had 175 (22.4%) patients. We therefore
analyzed the data from 607 patients who had good quality sleep study
records. SA was present in 63% of patients after MI with preserved
ejection fraction (PEF) and in 72% of patients with REF (LVEF <45%),
p = 0.05. Moderate to severe SA was present in 33.1% of patients after
MI. There was a higher total mortality in the REF (21.7%) than in the
PEF (10.6%) group of patients with moderate to severe SA (p = 0.033).
Independent predictors of mortality according to the multivariate anal-
ysis were type 2 diabetes mellitus (OR 5.003, 95% CI 1.968–12.717,
p = 0.001), history of previous MI (OR 4.633, 95% CI 1.832–11.718,
p = 0.001), age (OR 2.326, 95% CI 1.417–3.819, p = 0.001) and apnea
index (OR 1.216, 95% CI 1.023–1.445, p = 0.027).
Conclusions: MI patients with moderate to severe SA and left ven-
tricular systolic dysfunction had worse long-­term prognosis than
those with preserved systolic function and independent predictors
of long-­term mortality are type 2 diabetes mellitus, history of previ-
ous MI, age and apnea index.
Disclosure: Nothing to disclose.
O04 | Impact of sleep apnea on the overall
cardioembolic risk in patients with atrial
fibrillation: a cross-­sectional analysis of the
ESADA cohort
M.F. Pengo1; A. Faini1; L. Grote2; O. Ludka3,4,5; P. Joppa6;
A. Pataka7; Z. Dogas8; S. Mihaicuta9; H. Hein10; U.
Anttalainen11; S. Ryan12; C. Lombardi1; G. Parati1; The
European Sleep Apnoea Database (ESADA)
1
Department of Cardiovascular, Neural and Metabolic Sciences, Istituto
Auxologico Italiano, Milano, Italy; 2Sleep Disorders Center, Sahlgrenska
University Hospital, Gothenburg University, Gothenburg, Sweden;
3
Department of Internal Medicine and Cardiology, University Hospital
Brno; 4International Clinical Research Center, St. Anne's University
Hospital; 5Faculty of Medicine, Masaryk University, Brno, Czech Republic;
6
University Hospital L. Pasteur Košice – Univerzitnej Nemocnice L. Pasteura
Košice, Košice, Slovakia; 7Department of Respiratory Medicine, Respiratory
Failure Unit, G.Papanikolaou Hospital, Medical School, Aristotle University
of Thessaloniki, Thessaloniki, Greece; 8Sleep Medicine Center, Department
of Neurosciences, University of Split School of Medicine, Split, Croatia;
9
Pulmonology Dept, CardioPrevent Foundation, University of Medicine and
10
Pharmacy Victor Babes Timisoara, Timisoara, Romania; Sleep Disorders
11
Center, Reinbeck, Germany; Sleep Research Centre, Department of
Pulmonary Diseases and Clinical Allergology, University of Turku, Turku,
12
Finland; Pulmonary and Sleep Disorders Unit, St Vincent's University
Hospital and School of Medicine, University College Dublin, Dublin, Ireland
Objectives/Introduction: Atrial fibrillation (AF) is the most common
supra-­ventricular arrhythmia worldwide and is one of the causes of
ABSTRACTS
ischemic stroke. Obstructive sleep apnea (OSA) and AF often coexist
and share several predisposing factors. In patients with AF, assess-
ment of thromboembolic risk, and subsequent use of appropriate
therapy is crucial for stroke prevention. The aim of the present study
is to understand if the presence of OSA carries a significant addi-
tional cardioembolic risk to patients with AF.
Methods: The ESADA Study prospectively collects data from unse-
lected adult patients aged 18–80 years with suspected OSA referred
European sleep centres. In the present study, patients with OSA and
AF were included and the CHA2DS2-­VASc score was calculated ac-
cording to current guidelines. Based on ESC guidelines on AF, pa-
tients were stratified into 3 risk categories: low, moderate and high
risk of cardio-­embolic events.
Results: Cross‐sectional data of 14646 patients were included in the
analysis. From the total sample, a cohort of 363 patients with AF was
analysed. The distribution of CHADVASC score is shown in figure
1. ODI, but not AHI, was significantly increased in category 1 and
≥2 when compared to low cardioembolic risk (Chi-­squared p-­value
<0.01). Similarly, lowest SpO2 was significantly reduced with the in-
crease of CHADVASC risk score categories.
Conclusions: The analysis of the ESADA cohort confirms that OSA
severity is associated with an increased cardioembolic risk in pa-
tients with atrial fibrillation. In particular, ODI but not AHI showed a
significant association with CHADVASC score suggesting a potential
role of intermittent hypoxia in the risk of developing cardio embolic
complications such as stroke in patients with OSA and AF.
Disclosure: Nothing to disclose.
O05 | Nocturnal pulse rate variability analysis
in patients with positional obstructive sleep
apnoea
D. Álvarez1,2,3; C.A. Arroyo1; A. Crespo1,2; J.F. de Frutos1; A.
Cerezo-Hernández1; F. Moreno1; G.C. Gutiérrez-Tobal2,3; R.
Hornero2,3; F. del Campo1,2,3
1
Pneumology Department, Río Hortega University Hospital;
2 O06 | Effect of continuous positive airway
Biomedical Engineering Group, University of Valladolid; 3Centro
de Investigación Biomédica en Red en Bioingeniería, Biomateriales y
Nanomedicina (CIBER-­BBN), Valladolid, Spain
Objectives/Introduction: Tachycardia and bradycardia patterns
linked with apnoeic events have been found to be more severe dur-
ing the supine position. However, their potential influence towards
higher cardiovascular dysfunction on patients showing positional
obstructive sleep apnoea (POSA) has been scarcely analysed. This
study was aimed at assessing differences in heart rate modulation
between POSA and non-­POSA patients by means of non-­linear anal-
ysis of nocturnal pulse rate variability (PRV).
Methods: Patients showing clinical symptoms of sleep disordered
breathing were asked to participate in an ambulatory study focused
on the reliability of obstructive sleep apnoea (OSA) characterisation
|
      3 of 356
at home. All subjects performed unsupervised portable polysom-
nography (PSG) and simultaneous nocturnal pulse-­oximetry (NPO).
The apnoea-­hypopnoea index (AHI) from at-­home PSG was used to
characterise OSA. Positional patients were identified according to
Amsterdam POSA classification (APOC). PRV recordings from NPO
were used to assess cardiovascular modulation. Multiscale entropy
(MSE), which quantifies disorderliness (irregularity) of a time series
in different time scales, was used to investigate non-­linear dynamics
of PRV in POSA and non-­POSA patients. Mann-­Whitney and Chi2
tests were used to assess statistical differences between groups. All
p-­values <0.05 were considered statistically significant.
Results: A total of 336 subjects were involved: 16 were withdrawn
due to technical issues during unsupervised NPO while 87 did not
fit with APOC rules to discard/confirm POSA (AHI ≥5 events/h and
at least 10% of sleep time in both supine and non-­supine positions).
Accordingly, 233 patients were analysed: 129 (72.1% males) were
classified as POSA (APOC I, II or III), with median age of 56.0 [inter-
quartile range 44.8–63.0] years and body mass index (BMI) of 27.7
[26.0–31.3] kg/m2, while 104 (71.2% males) were non-­POSA, show-
ing median age of 57.5 [49.0–67.0] years (p = 0.058) and BMI of 29.8
[26.6–34.7] kg/m2 (p = 0.009). PRV recordings from POSA patients
systematically showed higher entropy in the first (0.25 [0.20–0.31]
vs. 0.22 [0.18–0.27]; p = 0.004), second (0.41 [0.34–0.48] vs. 0.37
[0.29–0.42]; p = 0.004) and third (0.52 [0.43–0.60] vs. 0.50 [0.38–
0.57]; p = 0.015) scales compared to non-­POSA patients.
Conclusions: PRV recordings from POSA patients showed marked ir-
regularity in nocturnal cardiac modulation compared with non-­POSA
subjects.
Disclosure: This work has been partially supported by ‘Ministerio
de Ciencia Innovación y Universidades’ and European Regional
Development Fund (FEDER) under project DPI2017-­
8 4280-­
R;
‘Sociedad Española de Neumología y Cirugía Torácica’ (SEPAR)
under project 66/2016; ‘Gerencia Regional de Salud de Castilla y
León’ under project GRS 1472/A/17; and by CIBER-­BBN (ISCIII), co-­
funded with FEDER funds.
pressure on the burden of arrhythmia in patients
with paroxysmal atrial fibrillation and sleep
apnea: a randomized controlled trial
G.M. Traaen1; L. Aakerøy2; T.-E. Hunt1; B. Øverland3;
C. Bendz1; L.Ø. Sande1; S. Aakhus2; M. Fagerland1; S.
Steinshamn2; O.-G. Anfinsen1; R. Massey1; K. Broch1; J.P.
Loennechen2; H. Akre1; L. Gullestad1
1
Oslo University Hospital, Oslo; 2St. Olavs Hospital, Trondheim;
3
Lovisenberg Hospital, Oslo, Norway
Objectives/Introduction: Sleep apnea (SA) has been associated
with atrial fibrillation (AF). However, it is uncertain whether treat-
ment with continuous positive airway pressure (CPAP) can reduce
 |
4 of 356       ABSTRACTS
AF burden. We aimed to assess the effect of CPAP in patients with
SA and paroxysmal AF.
Methods: This open-­label, parallel-­group, randomized, controlled
trial was conducted at two cardiology centers. Consecutive patients
aged 18–75 with paroxysmal AF and moderate-­to-­severe SA (apnea-­
hypopnea index ≥15) were eligible. All patients underwent respira-
tory polygraphy. After a run-­in period for CPAP-­tolerance, patients
were randomly assigned (1:1) to 5 months’ treatment with CPAP plus
usual care or usual care alone. Randomization was done on an online
platform. Because of its nature, the intervention was not blinded
to patients or investigators; however, outcome assessment was
blinded. The primary endpoint was the percent time in AF during
the last 3 months of the intervention adjusted for study site and the
percent time in AF at baseline. Time in AF was measured by implant-
able loop recorders. The primary analysis was done according to the
intention-­to-­treat principle.
Results: We performed respiratory polygraphy in 579 patients with
AF; 244 (42.1%) patients had moderate-­to-­severe SA, of whom 158
entered the CPAP-­tolerance test. Forty (25%) patients did not toler-
ate the treatment, and nine (5.7%) declined or met exclusion criteria.
Between January 2016 and February 2019, we randomly assigned
109 patients to treatment with CPAP (n = 55) or usual care (n = 54).
AF burden was evenly distributed across groups at baseline. One-­
hundred-­eight patients were available for the primary analysis. The
mean CPAP adherence was 4.3 ± 1.9 hour/night. The mean time in
AF decreased from 5.6% at baseline to 4.1% during the last 3 months
of intervention in the CPAP group and from 5.0% to 4.3% in the
usual care group. The adjusted between-­group difference at follow-
­up was −0.63 (95% confidence interval: −2.55 to 1.30) percentage
points; p = 0.52. Seven (11%) serious adverse events occurred in the
CPAP group, and two (3.7%) occurred in the usual care group. A two-­
sided p-­value <0.05 was considered significant.
Conclusions: Treatment with CPAP did not reduce the burden of AF
in patients with moderate-­to-­severe SA.
Disclosure: Gunn Marit Traaen has received speaker honoraria from
ResMed. The authors report no other relationships that could be
construed as a conflict of interest.
OR AL 2 – INSOMNIA
O07 | The effect of internet-­guided cognitive,
behavioral and chronobiological interventions
on depressive symptoms and brain function in
depression-­prone insomnia subtypes
J. Leerssen1,2; J.C. Foster-Dingley1; O. Lakbila-Kamal1,2;
A.C.W. Albers1; T.F. Blanken1,2; T. Bresser1,2; L.M.S.
Dekkers1; S.J. Houtman1; S.L.C. Ikelaar1; G.J.M. van der-
Lande1; B. te Lindert1; T. Maksimovi1; J.E. Reesen1; R.
Wassing1; J.R. Ramautar1; E.J.W. Van Someren1,2,3
1
Department of Sleep and Cognition, Netherlands Institute for
Neuroscience; 2Department of Integrative Neurophysiology, Center
for Neurogenomics and Cognitive Research (CNCR), Amsterdam
Neuroscience; 3Department of Psychiatry, Amsterdam UMC,
Amsterdam Neuroscience, VU University Amsterdam, Amsterdam, The
Netherlands
Objectives/Introduction: Insomnia is an important symptom of
depression and a modifiable major risk factor for its development.
Cognitive behavioral therapy for insomnia (CBT-­I) is an interven-
tion that could prevent depression. So far, no study has investigated
whether depression can be prevented in pre-­selected depression-­
prone insomnia subtypes. The current study aims to investigate
whether different interventions targeting insomnia prevent the de-
velopment and worsening of depressive symptoms in depression-­
prone insomnia subtypes.
Methods: A total of 134 participants (mean age: 48 years, 73% fe-
male) were included, each diagnosed with Insomnia Disorder and
subtyped as being depression-­prone. Participants were randomized
to 6 weeks of internet-­guided CBT-­I, or chronobiological therapy
(CT), or a combination thereof (CBT-­I + CT), or treatment as usual
(TAU). Depression severity was measured with the Inventory of
Depressive Symptoms at onset, and at four follow-­ups spanning
1 year (post-­treatment, 6 months, 9 months and 1 year). Before and
after treatment, fMRI was used to assess the brain response to emo-
tional faces (Hariri et al. 2002).
Results: Linear mixed models comparing pre-­and post-­treatment
showed a significant decrease in depression severity after CBT-­I
(d  =  −1.1, p <0.001), or CBT-­I + CT (d  =  −0.8, p = 0.002), but not
after CT only (d = −0.4, p = 0.163), while the TAU group showed an
increase in depression severity. There was no additional effect of
CBT-­I + CT, as compared to CBT-­I (d = 0.2, p = 0.413). At 6 months
follow up, compared to pre-­treatment, there was again a signifi-
cant stronger decrease in depression severity after CBT-­I (d = −0.9,
p = 0.002), or CBT-­I + CT (d = −0.9, p = 0.003), but not after CT only
(d = −0.2, p = 442). We will moreover show how these interventions
relate to emotional brain activation measured with fMRI.
Conclusions: Pre-­
selection of three depression-­
prone insom-
nia subtypes, allows for a sensitive assessment of preventing the
ABSTRACTS
development and worsening of depressive symptoms. Targeting
insomnia seems useful, also in those that are at the highest risk of
developing depression. Data are currently being collected for the 9
and 12-­month follow-­up measurements.
Disclosure: Nothing to disclose.
O08 | Arousals during sleep are associated
with cortical amyloid-­β burden and cognition in
healthy older adults
D. Chylinski1; M. Van Egroo1; J. Narbutas1; D. Coppieters2;
C. Degueldre1; C. Berthomier3; P. Berthomier3; M.
Brandewinder3; C. Schmidt1,4; P. Maquet1,5; E. Salmon1,4,5;
M.A. Bahri1; C. Bastin1,4; F. Collette1,4; V. Muto1; G.
Vandewalle1
1
GIGA – In Vivo Imaging, Cyclotron Research Centre, Liège
University; 2Department of Electrical Engineering and Computer
Science, University of Liège, Liège, Belgium; 3PHYSIP, Paris, France;
4
Psychology and Cognitive Neuroscience Research Unit, University of
5
Liège; Department of Neurology, University Hospital of Liège, Liège,
Belgium
Objectives/Introduction: Arousals during sleep have been studied
in sleep pathologies such as sleep apnoea and periodic limb move-
ment disorder, or in interventional experimental protocols triggering
arousals through external stimulations (mainly noise). Those stud-
ies generally pointed towards a detrimental role of arousals. Yet,
the causes and consequences of spontaneous arousals in healthy
individuals remain largely unknown. Recently, a bidirectional detri-
mental link between sleep-­wake dysfunction and the pathogenesis
of Alzheimer's disease is emerging in the literature, including the ab-
normal accumulation of amyloid-­β (Aβ) and tau protein in the brain.
Here, we investigated whether spontaneous arousals during sleep
were associated with Aβ and tau burden, as well as with cognitive
performance.
Methods: We recorded night-­
time sleep of 101 cognitively nor-
mal older individuals devoid of sleep disorders (aged 51–69; mean
59 ± 5; 68 females) under EEG. We assessed 18F-­
flutemetamol
and 18F-­THK 5351 regional brain uptake using Positron Emission
Tomography to infer their level of Aβ and tau protein burden, re-
spectively. Validated automatic arousal detection was computed on
all EEG recordings. All participants completed an extensive cognitive
battery of neuropsychological tasks to assess memory, attentional,
and executive functioning while well-­rested.
Results: Generalised linear mixed models analyses revealed that
arousals concomitant to a muscular tone increase (arousals EMG)
are significantly negatively associated with Aβ burden in the cor-
tex (F(1,95) = 11.62, p = 0.001), while correcting for age, sex and
total sleep time, whereas no such relationship was observed for tau
(p = 0.47). Furthermore, global cognitive performances were posi-
tively linked with arousals EMG throughout the night (F(1,95) = 6.38,
|
      5 of 356
p = 0.01), the observed relationship being mainly driven by per-
formances in the attentional (p = 0.005) and executive domain
(p = 0.04), after adjusting for age, sex, education and total sleep time.
Conclusions: These findings suggest arousals during sleep may form
a heterogeneous category of events composed of arousals evoked
by external or pathological event, that may be deleterious, and spon-
taneous arousals that may be associated with better brain structure
or cognition. Future research should try to further characterise
arousal events to disentangle what has been so far taring everyone
with the same brush.
Disclosure: Nothing to disclose.
O09 | Consistent altered internal capsule white
matter microstructure in insomnia disorder
T. Bresser1,2; J.C. Foster-Dingley1; R. Wassing1; J. Leerssen1;
J.R. Ramautar1; D. Stoffers1; O. Lakbila-Kamal1; M.P. van den
Heuvel3,4; E.J.W. van Someren1,2,5
1
Sleep and Cognition, Netherlands Institute for Neuroscience;
2
Department of Integrative Neurophysiology, Center for Neurogenomics
and Cognitive Research (CNCR), Amsterdam Neuroscience; 3Dutch
Connectome Lab, Department of Complex Trait Genetics, Center for
Neurogenomics and Cognitive Research, Vrije Universiteit Amsterdam;
4
Department of Clinical Genetics, Amsterdam Neuroscience,
VU University Medical Center; 5Department of Psychiatry, Vrije
Universiteit Amsterdam, Amsterdam, The Netherlands
Objectives/Introduction: Insomnia disorder remains a major burden
for individuals and society alike. While the current first-­line treat-
ment is highly effective on average, it brings insufficient relief to a
considerable proportion of people. Knowledge of underlying vul-
nerabilities and associated deviations in brain structure and func-
tion can provide rational targets for developing novel treatments. In
general, the suggested neural correlates of insomnia disorder have
been hard to replicate. White matter microstructure is a sparsely
studied field and its most consistent finding, altered white-­matter
microstructure in the anterior limb of the internal capsule, is based
on only a handful studies. The urge for replicable targets to under-
stand the underlying mechanisms of insomnia made us study white-­
matter fractional anisotropy (FA) across three independent samples
of cases and controls.
Methods: 3-­Tesla MRI diffusion tensor imaging data of three inde-
pendent samples were combined for analysis, resulting in n = 137
participants, of whom 73 were diagnosed with insomnia disorder
and 64 were matched controls without sleep complaints. Insomnia
severity was measured with the Insomnia Severity Index (ISI). White
matter microstructure was assessed with FA. White matter tracts
were skeletonized and analyzed using Tract-­Based Spatial Statistics.
We performed a region-­of-­interest analysis using linear mixed-­effect
models to evaluate case-­control differences in internal capsule FA
 |
6 of 356       ABSTRACTS
as well as associations between internal capsule FA and insomnia
severity.
Results: FA in the right limb of the anterior internal capsule was lower
in insomnia disorder than in controls (b  =  −9.76e−3; SE = 4.17e−3,
p = 0.034). In the entire sample, a higher Insomnia Severity Index
score was associated with a lower FA value of the right internal cap-
sule (b = −8.05e−4 FA/ISI point, SE = 2.60e−4, p = 0.008). Ancillary
whole brain voxel-­wise analyses showed no significant group differ-
ence or association with insomnia severity after correction for mul-
tiple comparisons.
Conclusions: The internal capsule shows small but consistent
insomnia-­
related alterations in its white matter microstructure.
Interestingly, this tract connects many brain areas previously impli-
cated in insomnia. Considering this our results support a network-­
based model in which the risk of insomnia involves a vulnerability
anywhere in this circuit, not necessarily showing voxel-­wise overlap
across individuals.
Disclosure: Nothing to disclose.
O10 | Dreaming and insomnia: link between
physiological parameters of rapid eye movement
sleep and mentation characteristics
F. Benz; D. Riemann; B. Feige
Department of Psychiatry and Psychotherapy Medical Center,
University of Freiburg, Faculty of Medicine, Freiburg, Germany
Objectives/Introduction: Insomnia disorder is a highly prevalent dis-
order and associated with an increased risk for somatic and mental
illness. An unresolved phenomenon is a discrepancy between objec-
tively measured sleep and subjective complaints. It has been shown
that rapid eye movement (REM) sleep might be especially vulner-
able to an altered perception. The present work aimed to investigate
the link between physiological REM parameters (number of arous-
als, REM density, spectral power) and mentation characteristics in
REM sleep (clarity, control, visuality, emotional valence, perceived
wakefulness).
Methods: 22 patients with insomnia disorder and 23 good sleepers
indicating at least one REM mentation within an awakening study
were included. Multivariate analyses of variance (MANOVAs) were
calculated to examine group differences and effects of mentation
characteristics on number of arousals, REM density and spectral
power prior to awakenings.
Results: Using Wilk's Lambda statistic, there was a significant mul-
tivariate effect of mean perceived wakefulness on mean spectral
power, Λ = 0.64, F(6, 30) = 2.86, p < 0.05. Increased perceived wake-
fulness was related to significantly reduced delta, theta and alpha
power in the minute prior to the REM awakenings. With respect to
number of arousals and REM density, no significant effects of men-
tation characteristics and no group differences were found.
Conclusions: Our results suggest that spectral power in REM sleep is
linked with altered sleep perception. Reduced delta, theta and alpha
power might be a signature of this modified REM sleep associated
with a high level of perceived wakefulness. Future awakening stud-
ies are necessary to further explore the link between physiological
REM parameters and sleep perception.
Disclosure: The authors declare no conflict of interest. This research
was funded by the Deutsche Forschungsgemeinschaft (DFG, RI
565/13-­1).
O11 | Effectiveness of a guided online
cognitive behavioral treatment (i-­Sleep) for
primary care patients with insomnia
A. van Straten1; T. van der Zweerde1; J. Lancee2
1
Clinical Psychology, Vrije Universiteit Amsterdam; 2Clinical
Psychology, Universiteit van Amsterdam, Amsterdam, The Netherlands
Objectives/Introduction: The general practitioner (GP) is usually the
first to notice insomnia. GPs should then offer Cognitive Behavioral
Treatment (CBTi) but most patients only receive medication. GPs
don't have the knowledge or expertise to provide CBTi. We exam-
ined the effectiveness of online CBTi in primary care compared to
care-­as-­usual (with access to intervention after 26 weeks).
Methods: Fifty GPs and 20 nurses participated in this study. Patients
were recruited during GP consultations as well as through screen-
ing questionnaires. Those (18+) fulfilling the DSM-­5 criteria for an
Insomnia Disorder (self-­report) were included. We used CBTi based
i-­Sleep which consists of 5 lessons. Patient receive online feed-
back by a primary care nurse. Use of sleep medication was allowed.
Assessments took place at baseline (t0), after treatment (8 weeks,
t1), and at 26 weeks (t2). The primary outcome was the Insomnia
Severity Index (ISI).
Results: A total of 134 patients were included (mean ISI score 19,
moderately severe insomnia). Of the 69 patients receiving i-­Sleep,
68% completed the whole intervention. The ISI scores of the inter-
vention patients at post-­test (mean 11.04, SE 0.81) were significantly
better than those of the control patients (mean 16.99; SE 0.74;
p < 0.01). The intervention group also outperformed the control
group (p < 0.05) on: SOL, WASO, NWAK, TWAK, SE, sleep quality,
and depressive symptoms. No significant effects could be demon-
strated for TST, daytime functioning, fatigue or anxiety symptoms.
After 26 weeks there were significant results for the ISI, SE and TST
and a large difference in the use of sleep medication (13% versus
29%).
Conclusions: This study showed that it is feasible to offer online
CBTi in primary care with two-­thirds fully completing CBTi. The pa-
tients showed a marked improvement in insomnia. The study shows
that online CBTi is a useful treatment in primary care. Efforts are
now made to implement this treatment broadly.
ABSTRACTS
Disclosure: The authors have developed I-­Sleep and own the intel-
lectual property rights. They make it available to cost price without
profit.
O12 | Cognitive behavioural therapy for
insomnia among shift workers: analyses of an
RCT study up to 24 months post-­treatment
H. Järnefelt1,2; M. Härmä1; M. Sallinen1,3; T. Paajanen1; J.
Virkkala1; K.-P. Martimo1; C. Hublin1
1
Finnish Institute of Occupational Health; 2Department of Psychology
and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki;
3
Department of Psychology, University of Jyväskylä, Jyväskylä, Finland
Objectives/Introduction: The aim of the study was to compare the
implementation and effectiveness of group and self-­help based
cognitive behavioural therapy for insomnia (CBT-­I) and sleep hy-
giene guidance in a randomized controlled design among shift
workers with insomnia. In addition, we detected participants for
features of shift work disorder (SWD) and analysed if they affected
the results.
Methods: A total of 59 shift workers with insomnia disorder were
recruited by six occupational health (OH) centers and participated in:
a) group-based CBT-I,
b) computerized self-help CBT-I, or
c) sleep hygiene guidance.
The interventions were delivered by trained OH nurses and psychol-
ogists. The outcomes were evaluated before and after the interven-
tions and at 6-­, 12-­and 24-­month follow-­ups using questionnaires,
sleep diary and actigraphy.
Results: Perceived severity of insomnia (p < 0.001), sleep-­related
dysfunctional beliefs (p < 0.001), burnout symptoms (p < 0.001), self-­
reported restedness after a sleep period and recovery after a work
shift (both p = 0.006), as well as actigraphy-­based total sleep time
(TST) (p = 0.037) improved significantly after all three interventions
and these improvements were mainly maintained at 12-­and 24-­
month follow-­ups. Mood symptoms decreased after group-­based
CBT-­I up to 12-­month follow-­up (p = 0.031). Half of the participants
had features of SWD. Participants without SWD features suffered
significantly more common from mental disorders, had more com-
mon sleep-­promoting medication (SPM), and reported having more
pronounced insomnia severity, dysfunctional beliefs and mood
symptoms than participants with SWD features. Participants with-
out SWD features also showed greater post-­intervention improve-
ments in dysfunctional beliefs, actigraphy-­
based TST, and SPM
usage than those with SWD features.
Conclusions: Our results indicate that all three interventions can be
effectively implemented in OH centers. The benefits of both CBT-­I
interventions and sleep hygiene guidance are rather similar and
|
      7 of 356
long-­standing among shift workers. The main added value of group-­
based CBT-­I seems to be the alleviation of mood symptoms. Having
SWD features may reduce the benefits of the interventions.
Disclosure: Heli Järnefelt has received a grant from The Association
of Finnish Non-­fiction Writers. Kari-­Pekka Martimo has received
speaker honorariums from pharmaceutical companies Lundbeck and
Pfizer. The other authors have nothing to disclose.
O R A L 3 – N E T WO R K S & CO N N EC TI V IT Y
O13 | Synaptome maps of the brain change
with circadian cycle and sleep deprivation in mice
D. Koukaroudi; Z. Qiu; T. Wong; N.H. Komiyama; S.G.N.
Grant
Genes to Cognition Program, Centre for Clinical Brain Sciences,
University of Edinburgh, Edinburgh, United Kingdom
Objectives/Introduction: The molecular and morphological fea-
tures of individual synapses can be systematically mapped at
single-­s ynapse resolution on a brain-­w ide scale in mice using syn-
aptomic methods (Zhu et al., 2018; Cizeron et al., 2020). Here,
we use these methods to ask which synapses in the brain change
during the circadian cycle and with sleep deprivation.
Methods: 3–4-­month-­old mice expressing synaptic proteins PSD95,
SAP102 and Arc tagged with fluorophores eGFP, mKO2 and Venus,
respectively, enabled the visualization of synapses expressing these
proteins, and neuronal cell bodies containing Arc. For the circadian
cycle studies, brains of PSD95eGFP/SAP102mKO2 mice (N = 8–10)
were collected at three time points (ZT, Zeitgeber Time: 6, 11, 23)
and of ArcVenus (N = 6–10) at six (ZT: 3, 7, 11, 15, 19, 23). For the
sleep deprivation study, PSD95eGFP/SAP102mKO2 mice (N = 8–10)
were sleep-­deprived by gentle handling for 6 hours from lights-­on.
Whole brain sections were imaged using a spinning disc confocal mi-
croscope permitting resolution of synaptic puncta and Arc-­positive
nuclei and the data registered to the Allen Brain Atlas. Two-­way
ANOVA (a = 0.05) and Two-­stage linear step-­up False Discovery
Rate procedure of Benjamini, Krieger, Yekutieli statistical tests were
employed.
Results: Results from the circadian studies showed marked PSD95
and Arc changes. For example, at the end of the light phase (ZT11)
compared to the end of the dark phase (ZT23), PSD95-­positive syn-
apses (p = 0.03), but not SAP102-­positive ones (p = 0.1), showed a
greater mean intensity in neocortical areas. At the beginning of the
dark phase (ZT15), synaptic Arc intensity was at its lowest level in
the majority of hippocampal regions (p = 0.02), as was the somatic
Arc density in the dentate gyrus and neocortex (p = 0.01), but not
in the rest of the brain regions examined. In the sleep deprivation
study, PSD95 puncta size was significantly reduced across cortical
 |
8 of 356       ABSTRACTS
regions compared to the time-­matched control group (p = 0.009) but
unaffected in subcortical structures.
Conclusions: In contrast to previous studies, which suggest that cir-
cadian cycle and sleep deprivation produce uniform changes across
the brain, synaptome mapping shows selected synapse types and
brain regions are affected. Each stage of the circadian cycle has a
characteristic synaptome architecture which requires sleep for its
maintenance.
Disclosure: Project funded by the European Research Council
(695568 SYNNOVATE) and the University of Edinburgh (Principal's
Career Development PhD Scholarship).
O14 | Association between sleep regulation
and neuroimaging-­derived myelin markers
M. Deantoni1; V. Muto1; G. Hammad1; C. Berthomier2;
M. Baillet1; M. Reyt1; M. Jaspar1,3; C. Meyer1,3; M. Van
Egroo1; E. Lambot1; S.L. Chellappa4; M. Brandewinder2; C.
Degueldre1; A. Luxen1; E. Salmon1; C. Phillips1; B. Evelyne1;
F. Collette1,5; D.-J. Dijk6; G. Vandewalle1; P. Maquet1,7; C.
Schmidt1,5
1 Brussel federation, Clerdent Foundation, Reine Elisabeth Medical
GIGA-­Institute, Cyclotron Research Center/In Vivo Imaging, Sleep and
2 Foundation, FRIA.
Chronobiology Lab, University of Liège, Liège, Belgium; Physip SA,
Paris, France; 3Walloon Excellence in Life Sciences and Biotechnology
(WELBIO), Wavre, Belgium; 4Departments of Medicine and Neurology,
Brigham and Women's Hospital, Medical Chronobiology Program,
Division of Sleep and Circadian Disorders, Boston, MA, United States;
5
Psychology and Cognitive Neuroscience Research Unit, University of
Liège, Liège, Belgium; 6Surrey Sleep Research Centre, Faculty of Health
and Medical Sciences, University of Surrey, Guildford, United Kingdom;
7
Department of Neurology, CHU Liège, Liège, Belgium
Objectives/Introduction: Sleep plays a crucial role in brain plasticity,
and has been suggested to be involved in myelin organization. Here,
we assessed the association between sleep homeostatic responses
and quantitative MRI-­derived myelin content in a sample of healthy
young men.
Methods: 238 male participants (age: 22.1 ± 2.7) underwent an in-­
lab protocol to assess homeostatic responses in slow wave and REM
sleep through a modulation of prior wakefulness and sleep duration.
The protocol encompassed four conditions: a baseline night (BAS,
duration adjusted on participant's sleep-­wake schedule), a 12 h sleep
extension night (EXT) followed by a 4-­h nap and an 8-­h sleep op-
portunity night (sleep saturation; SAT) and a 12 h recovery night
(REC) following 40-­hours sleep deprivation. For each night, four
sleep parameters were extracted: sleep slow wave activity at the
beginning of the night (SWA0), its overnight exponential dissipation
rate (tau), and overnight mean theta and beta power per REM epoch.
Participants underwent a multiparameter brain MRI protocol at 3T
to extract quantitative maps sensitive to different myelin biomark-
ers. F-­contrasts were calculated to assess whether the modularity of
sleep parameters across sleep conditions explains variance in myelin
biomarkers. Reported statistics are family-­wise-­error corrected over
the entire brain volume (pFWE < 0.05).
Results: Slow wave sleep duration and SWA0 were modulated
across all sleep conditions (REC>BAS>EXT>SAT; all p < 0.001), while
REM sleep percentage significantly differed only between SAT and
the other sleep contexts (F(3,1257) = 13.676743, p < 0.001). The
modulation of NREM SWA0 was associated with myelin content in
the medio-­temporal lobe, encompassing the bilateral hippocampus
and entorhinal cortex, while the modulation of REM beta power was
associated to myelin content in diffuse thalamocortical tracts and
overhead cortices.
Conclusions: Spectral power in sleep-­
specific frequency bands
across sleep homeostasis contexts is associated with myelin content
in the hippocampus and surrounding cortices as well as thalamocor-
tical fibers. The hippocampus has been proposed as a key player for
temporal coupling of brain oscillations, while thalamocortical fibers
myelination may facilitate the cortical response to sleep-­dependent
diencephalic activity. As myelin stands for conduction velocity, it
could facilitate the modulation of brain electrical oscillations, and
putatively also the homeostatic response of sleep.
Disclosure: Funding: Welbio, FNRS, ULiège, ARC of Wallonia-­
O15 | Association of REM sleep with brainstem
myelin content among healthy young and older
individuals
P. Talwar1; M. Deantoni1; M. Van Egroo1; V. Muto1,2;
D. Chylinski1; J. Narbutas1,2; E. Koshmanova1; C.
Degueldre1; M. Jaspar1,2; C. Meyer1,2; C. Berthomier3; M.
Brandewinder3; A. Luxen1; E. Salmon1,4,5; C. Bastin1,4; F.
Collette1,4; P. Maquet1,2,5; C. Schmidt1,2; C. Phillips1,6; E.
Balteau1; S. Sherif1; G. Vandewalle1
1
GIGA‐CRC In Vivo Imaging, Université de Liège; 2Walloon Excellence
in Life sciences and Biotechnology (WELBIO), Liege, Belgium; 3Physip
SA, Paris, France; 4Psychology and Cognitive Neuroscience Research
Unit, Université de Liège; 5Department of Neurology, Université de
Liège, Liege; 6GIGA‐In Silico Medicine, Université de Liège, Liège,
Belgium
Objectives/Introduction: Association of sleep features with brain-
stem structures involved in sleep-­wake regulation remain scarce in
humans. Here, we investigated whether myelin content in brainstem
regions was associated with physiological sleep parameters and
whether age modulates these associations.
Methods: In this prospective observational study, overnight EEG
and quantitative MRI were conducted on 219 young adults (18–
30 y; mean 22.0 ± 2.7; all males) and 101 healthy older individuals
(50–69 y; mean 59.4 ± 5.3; 33 males) to acquire respectively sleep
ABSTRACTS
parameters and magnetization transfer (MT) values, the latter being
directly related to myelin content. qMRI MT-­weighted maps were
computed using hMRI toolbox in SPM12. Automatic scoring was
used to extract REM percentage of total sleep time and power in the
delta (0.5–4 Hz) band of the EEG. APOE ε4 carrier status was also
assessed in both groups.
Results: Across the whole sample, general linear model analyses re-
vealed a significant association between REM sleep percentage and
MT values in the entire brainstem (F1,294 = 7.366, p = 0.007, R2 = 0.675,
2
adjusted R  = 0.668) and midbrain (F1,295 = 6.073, p = 0.014, ad-
justed R2 = 0.777), but not in pons (F1,294 = 3.494, p = 0.063, ad-
justed R2 = 0.597), after controlling for age, gender, BMI, and APOE
ε4 carrier status. Further analyses showed that REM percentage was
related to myelin content in the brainstem (F1,75 = 6.155, p = 0.015,
R2 = 0.177, adjusted R2 = 0.111) as well as in the pons in the healthy
aged cohort (F1,75 = 8.286, p = 0.005, adjusted R2 = 0.148) control-
ling for age, gender, BMI, APOE ε4 carrier status and education. In
contrast, none of the sleep parameters investigated were found to
be significantly associated with MT values in the pons, midbrain and
brainstem in young adults only (p > 0.05).
Conclusions: Our data show that brainstem myelin content is asso-
ciated with REM sleep in healthy individuals and potentially espe-
cially in older individuals. The data suggest that myelination of the
brainstem and especially of the pons, where the locus coeruleus is
located, may be essential to REM sleep preservation in aging. Our
study provides a working hypothesis to further evaluate the link be-
tween sleep architecture and brainstem structure.
Disclosure: Support: FNRS, ULiège, ARC17/21-­
09, FEDER, WBI,
Clerdent Foundation, Leon Frédéricq Foundation.
O16 | Role of sleep in brain cortical synaptic
remodelling following synthetic torpor in the rat
T. Hitrec1; M.A. Awadelkareem2; I.A. Azeez2; M. Cerri1,3;
M. Luppi1; D. Martelli1; A. Occhinegro1; E. Piscitiello1;
F. Squarcio1; C. Tesoriero2; D. Tupone1; G. Bertini2; M.
Bentivoglio2; R. Amici1
1
Department of Biomedical and Neuromotor Sciences, Alma Mater
Studiorum – University of Bologna, Bologna; 2Department of
Neurosciences, Biomedicine and Movement Sciences, University of
Verona, Verona; 3National Institute of Nuclear Physics, Bologna, Italy
Objectives/Introduction: Torpor/hibernation (TH) is a hypometa-
bolic state characterized by a strong reduction in body temperature.
During TH, a reversible synaptic rarefaction has been described.
Exit from TH is always followed by a sleep bout with high-­intensity
Delta activity, concomitant with synaptic restoration. A torpor-­like
condition (synthetic torpor, ST) has been induced in the rat, a non-­
hibernating mammal, by the inhibition of the key thermoregulatory
area Raphe Pallidus (Rpa). Since also ST is followed by a sleep bout,
|
      9 of 356
aim of this study was to assess the effects of ST and the role of post-
­ST sleep on brain cortical synaptic plasticity.
Methods: Ten male Sprague-­Dawley rats were implanted under gen-
eral anaesthesia with electrodes for electroencephalographic record-
ing, a microcannula within the RPa, and an intracerebral thermistor.
ST was achieved by means of multiple microinjections of muscimol
(GABA-­A agonist) within the RPa. Following a 1-­week recovery, rats
were sacrificed in different experimental conditions: i) Control (C, ve-
hicle injected into the RPa, n = 2); ii) Hypothermic nadir of ST (N, 6 h
after the start of muscimol microinjections, n = 2); iii and iv) 6 h after
the return to euthermia (RE), during which animals were either allowed
to sleep (6h-­S, n = 2) or sleep deprived by gentle handling (6h-­SD,
n = 2); v) 38 h after RE, left undirstubed (38h-­S, n = 2). Brains were im-
munohistochemically processed to study pre-­and post-­synaptic pro-
teins in the cellular bodies, to assess excitatory (glutamate vescicular
transporter+synaptic density protein, PSD-­95) and inhibitory (GABA
vescicular transporter+gephirin) axosomatic connections of the par-
valbuminergic interneurons of the barrel cortex.
Results: Results showed a significant (ANOVA: p < 0.05) decrease
in the total number (excitatory+inhibitory) of synapses per neuronal
soma in N (22.1 ± 2.0) compared to C (39.2 ± 3.5). This value gradu-
ally went back to control levels in 6h-­S (25.9 ± 3.8, n.s. vs. C) and
38h-­S (31.22 ± 3.7, n.s. vs. C). In 6h-­SD, the restoring process was
preserved, and even accelerated, although not statistically signifi-
cantly (33.9 ± 0.3, n.s. vs. C and vs. 6h-­S).
Conclusions: ST induces a large reduction of synaptic contacts at
the level of the parvalbuminergic interneurons of the barrel cortex.
Sleep deprivation does not significantly interfere with the restora-
tion of the number of synaptic contacts.
Disclosure: Nothing to disclose.
O17 | Disruption of hypocretin/orexin receptor
1 or 2 in dopaminergic neurons differentially
regulates waking theta and fast-­gamma oscillations
S. Li; M. Bandarabadi; M.-L. Possovre; M. Tafti; A. Vassalli
Department of Biomedical Sciences, University of Lausanne, Lausanne,
Switzerland
Objectives/Introduction: The hypocretin/Orexin (HCRT) system is
a brain circuit neuromodulator with essential functions in orches-
trating many physiological functions, including the architecture of
wake/sleep states. As HCRT downstream effectors, dopaminergic
(DA) neurons are modulated by signaling through hypocretin recep-
tor 1 (HCRTR1), hypocretin receptor 2 (HCRTR2), or both.
Methods: To address the complexity of the role of the HCRT-­to-­DA
pathway in sleep/wake regulation and EEG spectral quality, we se-
lectively disrupted Hcrtr1 and Hcrtr2 genes in DA neurons by using
Cre/lox technology with a dopamine transporter (Dat) Cre driver. We
analyzed the resulting Hcrtr1Dat-CKO (CKO1) and Hcrtr2Dat-CKO (CKO2)
mice and their control littermates by exposing them to various
 |
10 of 356       ABSTRACTS
behavioral paradigms, as their EEG/EMG activity was recorded, and
their behavior was video-­recorded.
Results: Using GFP to map Hcrtr1 and Hcrtr2 gene activity in the mid-
brain, we found that, respectively, 83% and 87% of tyrosine hydroxy-
lase (TH) positive neurons expressing Dat, co-­express GFP [83.0 ± 2.8%
for CKO1 (n = 2) and 87.2 ± 1.5% for CKO2 (n = 2)]. Mice with DA-­
selective Hcrtr2 disruption, but not inactivation in Hcrtr1, were found
to exhibit a dramatic and constitutive increase in time spent in an ‘ac-
tive’ or theta-­rich (6.0–9.5 Hz) state of wakefulness (defined as theta-­
dominant-­
wakefulness, TDW), relative to control littermates. CKO2
mice's altered waking state was observed spontaneously, or under en-
forced waking (EW), and was uncoupled to locomotor activity (baseline:
CKO2 vs. CTR2, p < 0.001; EW: CKO2 vs. CTR2, p < 0.001). CKO2 mice’
waking EEG theta and fast-­gamma (55–80 Hz) activities were highly en-
hanced during spontaneous and enforced waking (theta power in base-
line wake: CKO2 vs. CTR2, p < 0.001; EW: CKO2 vs. CTR2, p < 0.001;
gamma power in baseline wake: CKO2 vs. CTR2, p < 0.001; EW: CKO2
vs. CTR2, p < 0.001). Additionally, CKO2 mice manifested a delay in the
dynamics of paradoxical sleep (PS) recovery after EW (CKO vs. CTR2,
p = 0.0435). Lastly, we validated two CKO mouse models by showing
that the combined whole-­body KOs of Hcrtr1 and Hcrtr2 floxed allele
mice manifest typical cataplexies.
Conclusions: HCRT signaling in DA neurons has a profound impact
on brain oscillatory network activity, which is differentially regulated
through HCRTR1 or R2, and acts in diverse behavioral contexts.
Disclosure: Nothing to disclose.
O18 | Large-­scale brain network connectivity
during post-­learning sleep forecasts motor
memory consolidation: a high-­density
electroencephalography study
S. Titone1,2; J. Samogin1; N. Dolfen1,2; M. Veldman1,2; P.
Peigneux3; S. Swinnen1,2; D. Mantini1,4; G. Albouy1,2
1
Department of Movement Sciences, KU Leuven; 2LBI – KU
Leuven Brain Institute, Leuven; 3Neuropsychology and Functional
Neuroimaging Research Group (UR2NF) at the Centre for Research
in Cognition and Neurosciences (CRCN), Université Libre de Bruxelles
(ULB), Brussels, Belgium; 4Brain Imaging and Neural Dynamics
Research Group, IRCCS San Camillo Hospital, Venice, Italy
Objectives/Introduction: Magnetoencephalographic research has
shown decreases in long-­range functional connectivity (FC) during
sleep following motor sequence learning (MSL) compared to base-
line sleep (Tamaki et al., 2013). Here, we assessed, using high-­density
electroencephalography (hdEEG), whether source-­localized FC dur-
ing post-­
learning sleep is related to subsequent sleep-­
mediated
motor memory consolidation in young healthy adults.
Methods: Healthy right-­
handed participants (n = 17; mean age:
24.4 ± 3.5 y) were trained on a MSL task in the evening (training) and
were retested on the task the next morning (retest) after a full night of
sleep recorded with hdEEG. EEG data from 5-­minute episodes of wake-
fulness, stage NREM2, NREM3 and REM sleep from the first sleep cycle
of the night were analyzed using methods described in Liu et al. (2018).
Oscillatory activity in the delta (1–4 Hz), theta (4–8 Hz), alpha (8–12 Hz),
sigma (12–16 Hz) and beta (16–30 Hz) bands was source-­localized for
each sleep stage. FC was then assessed from the source-­reconstructed
signal within the motor network (MOT) and between MOT and the
default mode (DMN), dorsal attention (DAN), ventral attention (VAN),
language (LANG) and visual (VIS) networks. The relationship between
FC during sleep and motor memory consolidation was assessed with
correlations between the FC matrices and overnight changes in motor
performance. Correction for multiple comparisons was applied across
networks (6) within each family of hypotheses (i.e., within each fre-
quency band/sleep stage).
Results: Performance speed significantly improved during training
on the motor task (F(1, 15) = 69.268, p < 0.001) and after a night of
sleep (F(1, 15) = 10.364, p = 0.006). During NREM2 sleep, FC in the
alpha band within the MOT network but also between the MOT
and all the other networks was negatively correlated to offline
gains in performance (MOT: pFDRcor = 0.021; MOT&DMN: pFDRcor = 
0.021; MOT&DAN: pFDRcor = 0.018; MOT&VAN: pFDRcor = 0.026;
MOT&LANG: pFDRcor = 0.018; MOT&VIS: pFDRcor = 0.026). Similar
results were observed in NREM2 in the beta band but these cor-
relations did not survive FDR correction (MOT: puncor = 0.012;
MOT&DAN: puncor = 0.027). No other significant correlations were
observed in the other frequency bands and sleep stages.
Conclusions: Our results suggest that weaker FC within the motor
network but also between the motor and other networks during
post-­learning NREM2 sleep promotes sleep-­related motor memory
consolidation.
Disclosure: Nothing to disclose.
YO U N G S C I E NTI S T S S Y M P OS I U M
O19  |   CO RTI C A L R EG U L ATI O N O F
G LO BA L S LE E P H O M EOS TA S I S
L.B. Krone1,2; T. Yamagata2,3; C. Blanco-Duque1,2; M.C.C.
Guillaumin1,2,4; M.C. Kahn1,2; V. van der Vinne1,2; L.E.
McKillop1,2; S.N. Peirson2,3; C.J. Akerman5; A. Hoerder-
Suabedissen1; Z. Molnár1; V.V. Vyazovskiy1,2
1
Department of Physiology, Anatomy, and Genetics; 2Sleep and
Circadian Neuroscience Institute; 3Nuffield Department of Clinical
Neurosciences, University of Oxford, Oxford, United Kingdom;
4
Department of Health Sciences and Technology, Institute for
Neuroscience, ETH Zurich, Zurich, Switzerland; 5Department of
Pharmacology, University of Oxford, Oxford, United Kingdom
Objectives/Introduction: While sleep-­wake states are largely defined by
characteristic neocortical and hippocampal oscillations, the transitions
ABSTRACTS
between vigilance states are thought to be regulated subcortically.
Despite the well-­established phenomenon of ‘local sleep’ – the local and
use-­dependent regulation of slow waves in neocortex – the possibility
that cortical structures contribute to the global control of vigilance states
has been overlooked. Here, we test whether genetic inactivation of spe-
cific cortical neurons affects global sleep-­wake regulation.
Methods: We silenced a subset of neocortical layer 5 pyramidal and
archicortical dentate gyrus granule cells in mice using a cell-­specific ab-
lation of the key t-­SNARE protein SNAP25 (Rbp4-­Cre;Ai14;Snap25fl/fl).
Cortical Snap25-­ablated mice (HOM, n = 9) and Cre-­negative controls
(CTR, n = 6) were implanted with electroencephalography (EEG) and
electromyography (EMG) electrodes for chronic electrophysiological
recordings during undisturbed conditions and 6 h sleep deprivation. A
separate cohort (2 HOM, 3 CTR) underwent long-­term passive infrared
recordings for circadian phenotyping.
Results: In undisturbed conditions, cortical SNAP25-­ablated animals
showed unusually long wake bouts during the dark period, spent 31%
more time awake (13.83 ± 0.39 h) than control animals (10.57 ± 0.42 h,
t(13) = 5.55, p < 0.001), and the increase of EEG slow wave activity
(SWA, 0.5–4.0 Hz) relative to the duration of spontaneous wake epi-
sodes was significantly reduced F(1,57.37) = 6.44, p = 0.014). After
sleep deprivation, the initial increase of SWA was attenuated (HOM:
136.77 ± 3.98%, CTR: 180.57 ± 5.13%, first 30 min after sleep depriva-
tion, t(11) = 6.78, p < 0.001) and the overall amount of sleep during the
dark period was reduced compared to controls. All cortical SNAP-­25
ablated mice and controls were well entrained to a 12 h:12 h light dark
cycle. In constant darkness, all mice in both genotypes were rhythmic
(Qp periodogram peak in all animals: p < 0.05; mean free running period:
CTR 23.93 h, HOM 23.98 h) and phase shifted their activity phase in
response to a delaying 2 h light pulse.
Conclusions: Our study reveals a novel and unexpected role for
the cortex in sleep homeostasis and the global regulation of vigi-
lance states. Sleep-­wake history is not effectively encoded in cor-
tical SNAP25-­ablated mice. This profound homeostatic phenotype
is not accompanied by obvious alterations in the circadian activity
patterns. Hence, cortical manipulations might allow homeostatic and
circadian components of sleep-­wake regulation to be disentangled.
Disclosure: Nothing to disclose.
O20 | Human sleep slow waves are associated
with traveling hemodynamic waves at cortical level
M. Betta1; G. Handjaras1; A. Leo1; A. Federici1; V. Farinelli2;
F. Siclari3; E. Ricciardi1; S. Meletti2; D. Ballotta2; F. Benuzzi2;
G. Bernardi1
1
MoMiLab, IMT School for Advanced Studies Lucca, Lucca; 2Department
of Biomedical, Metabolic and Neural Sciences, University of Modena and
Reggio Emilia, Modena, Italy; 3Center for Investigation and Research on
Sleep, Lausanne University Hospital, Lausanne, Switzerland
Objectives/Introduction: Recent work described a link between
sleep slow waves, hemodynamic changes and CSF movement,
|
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suggesting a possible role of slow waves in the removal of brain
metabolic wastes. Of note, slow waves are not stationary events,
but instead propagate at cortical level through anatomically con-
nected pathways. Here, we investigated whether the spreading of
slow waves may determine a parallel propagation of hemodynamic
changes across the cortical mantle.
Methods: Seventeen healthy subjects (28.8 ± 2.3 y, 11F) underwent
simultaneous EEG (32 electrodes) and fMRI (3T) during an afternoon
nap opportunity. All EEG recordings were preprocessed to remove
fMRI-­
related and physiological artifacts (EEGLAB, FMRIB-­
plugin).
Then, slow waves (0.5–2 Hz) were detected in NREM sleep using an
automatic algorithm and their timing of occurrence, amplitude and du-
ration were used to build a regressor of interest for voxel-­wise fMRI
data analysis. In addition, a delay-­map of BOLD-­signal changes around
slow-­wave onset (−4/+8 s) was built by computing the cross-­correlation
between the mean signal of a significantly activated cortical area (seed)
and the mean signals of 200 ROIs covering the whole cortical mantle.
We directly compared the fMRI-­based delay-­map with a delay-­map of
EEG slow-­wave propagation in source space (sLORETA) obtained in a
different set of 12 subjects (25.5 ± 3.7 y, 6F) using 256-­electrodes EEG.
Results: We found that slow waves are associated with significant
(p < 0.01, FDR-corrected) BOLD-­signal increases in brainstem, cer-
ebellum and medial thalamus. At cortical level, a BOLD-­signal de-
crease was found to occur at different delays across distinct brain
areas, covering a broad extent of the cortical mantle and mirror-
ing the propagation of electrophysiological slow waves (correla-
tion, p = 0.0055). The lowest latency was found in the premotor/
somatomotor cortex and anterior insula, while the highest latency
was observed in inferior temporal areas. Finally, we found that the
amplitude of EEG slow waves is positively related to the magnitude
and inversely related to the delay of BOLD-­signal changes.
Conclusions: Our results demonstrate that coupled
electrophysiological-­
hemodynamic fluctuations orderly propagate
from a preferential origin in centro-­frontal brain areas to inferior
temporo-­occipital cortices. Slow-­wave propagation may generate a
gradient for CSF-­flow and the clearance of metabolic wastes, and
this mechanism could be especially efficient for large slow waves.
Disclosure: Nothing to disclose.
O21 | Association of anxiety scores at baseline
with long-­term adherence to CPAP in adults with
coronary artery disease and obstructive sleep
apnoea in the RICCADSA trial
Y. Celik1; E. Thunström2; Y. Peker1,2
1
Koc University Research Center for Translational Medicine (KUTTAM),
Istanbul, Turkey; 2University of Gothenburg Sahlgrenska Academy,
Gothenburg, Sweden
Objectives/Introduction: Obstructive sleep apnoea (OSA) is highly
prevalent among patients with coronary artery disease (CAD).
 |
12 of 356       ABSTRACTS
Continuous positive airway pressure (CPAP) is the first choice of
treatment for OSA patients with excessive daytime sleepiness.
Nevertheless, most of the patients with CAD do not report daytime
sleepiness, and adherence to CPAP is challenging in this high-­risk
population. We aimed to address the association of anxiety levels
at baseline with adherence to CPAP treatment in a revascularized
CAD cohort.
Methods: This study was a subanalysis of the RICCADSA trial, which
was conducted in Sweden between 2005 and 2013. Nonsleepy
(Epworth Sleepiness Scale Score [ESS] < 10) OSA patients (apnoea-­
hypopnoea index ≥15 events/h) randomized to CPAP (n = 119), and
sleepy (ESS ≥10) OSA patients being offered CPAP (n  = 151), who
filled the Zung Self-­rated Anxiety Scale (SAS; min: 20, max: 80) ques-
tionnaire at baseline were included. The SAS scores were catego-
rized in tertiles (low-­moderate-­high anxiety level, respectively) in
order to address the relationship between anxiety levels at baseline
and accumulated CPAP usage (h/day) at 12 month-­follow-­up.
Results: The distribution of the total SAS scores were similar at base-
line in both groups (30.5 ± 6.0 in nonsleepy OSA vs 31.7 ± 6.0 in
sleepy OSA; p = 0.094). The median CPAP usage was lower (1.3 h/
day) among patients in the highest SAS tertile (SAS score >33) com-
pared to the participants in the second and first tertile (4.1 h/day,
and 3.7 h/day, respectively; p < 0.001). In a multivariate backward
linear regression model, total SAS score at baseline was inversely
correlated with CPAP h/day at 12-­month follow-­up (β-­coefficient
−0.43; 95% confidence interval [CI] −0.26 to −0.12, p < 0.001). ESS
score (β-­coefficient 0.12 [95% CI 0.001–0.15], p = 0.046) and Zung
Self-­rated Depression Scale score (β-­coefficient 0.30 [95% CI 0.04–
0.12], p < 0.001) were positively correlated with CPAP adherence.
Conclusions: Anxiety levels at baseline was a significant predictor of
CPAP adherence at 12 months in this CAD cohort. Early recognition
of anxiety, and consequently, initiation of psychotherapeutic and/or
pharmacologic intervention for this condition may promote adher-
ence to CPAP in CAD patients with coexisting OSA.
Disclosure: Funded by the Swedish Research Council, the Swedish
Heart-­Lung Foundation, and the ResMed Foundation.
O22 | Are children genetically predisposed to
poor sleep? A polygenic risk score study in the
general pediatric population
D. Kocevska1,2,3; K. Trajanoska4,5; R.H. Mulder2,3; M.E.
Koopman-Verhoeff2,3; P.W. Jansen2,6; A.I. Luik 2,4; H.
Tiemeier2,7; E.J.W. van Someren1,8,9
1
Department of Sleep and Cognition, Netherlands Institute for
Neuroscience, Amsterdam; 2Department of Child and Adolescent
Psychiatry/Psychology, Erasmus MC University Medical Center; 3The
Generation R Study Group; 4Department of Epidemiology, Erasmus
MC University Medical Center Rotterdam; 5Department of Internal
Medicine, Erasmus MC University Medical Center; 6Department of
Psychology, Education and Child Studies, Erasmus School of Social and
Behavioral Sciences, Erasmus University, Rotterdam, The Netherlands;
7
The Department of Social and Behavioral Science, Harvard TH Chan
School of Public Health, Boston, MA, United States; 8Department
of Psychiatry, Amsterdam Public Health Research Institute and
Amsterdam Neuroscience Research institute, Amsterdam UMC, Vrije
Universiteit; 9Department of Integrative Neurophysiology, Center for
Neurogenomics and Cognitive Research, Amsterdam Neuroscience,
Vrije Universiteit, Amsterdam, The Netherlands
Objectives/Introduction: Twin studies show that sleep traits are
highly heritable: 46% for sleep duration and 40% for insomnia symp-
toms. Recent large-­scale genome wide association studies (GWAS)
have identified numerous common genetic variants involved in in-
somnia and sleep duration. These GWASs have however been con-
ducted in adults. The influence of these genetic variants on sleep
during childhood is thus unknown.
Objective: We aim to assess whether an individual's polygenic risk
scores (PRS) for insomnia (PRS-­I) and sleep duration (PRS-­SD) de-
rived from adults are associated with sleep in childhood and early
adolescence.
Methods: We included 2,458 children of European ancestry from
the Generation R Study for whom genotype and sleep data were
available. PRS-­
I and PRS-­
SD were based on the largest GWAS
studies to date, calculated at multiple p-­value thresholds using the
PRSice package. Sleep problems were reported by mothers at child's
age 1.5, 3 and 6 years using the Child Behavior Checklist, and as-
sessed with actigraphy in a subsample of 975 adolescents between
10–16 years of age. Associations of PRS and sleep variables were
estimated with linear regression.
Results: Higher PRS-­I was associated with more mother-­reported
sleep problems at 6 years (BPRS-I<5e08 = 0.1, 95%CI:0.02;0.2) and
using more inclusive more inclusive thresholds also with sleep prob-
lems at 1.5 years (BPRS-I<0.001 = 0.1, 95%CI:0.04–0.2). PRS-­SD was
not associated with mother-­reported sleep problems in childhood.
PRS-­I was not associated with actigraphic sleep estimates collected
at 10–16 years, adolescents with polygenic propensity for longer
sleep (PRS-­
SD) had longer total sleep time (BPRS-SD<5e08 = 0.05,
ABSTRACTS
95%CI: 0.001;0.1), and using more inclusive thresholds also more
wake after sleep onset (BPRS-SD<0.005 = 0.3, 95%CI:0.04;0.5).
Conclusions: Polygenic risk scores based on GWAS studies of sleep
in adults are associated with sleep patterns in an independent sam-
ple of children followed up to adolescence. These associations were
more pronounced later in development. Polygenic susceptibility for
insomnia is already reflected in problematic sleep in early childhood.
Children who are genetically predisposed to insomnia have more
insomnia-­like sleep problems, whereas those that are genetically
predisposed to longer sleep, sleep longer in adolescence.
Disclosure: The authors have no conflicts of interest to disclose. The
work was funded by NWA Startimpuls Royal Netherlands Academy
of Arts and Sciences 2017 Grant (AZ/3137) and by the European
Research Council grant ERC-­2014-­AdG-­671084 INSOMNIA.
RO U N D TA B LE 2 – S LE E P, I N S O M N I A A N D
D E PR E S S I O N : H OW A R E TH E S E LI N K E D?
O23 | Sleep, insomnia, and emotion regulatory
processes
1,2
C. Baglioni
1 quality studies in patients with clinically diagnosed major depressive
Department of Psychiatry and Psychotherapy, University of Freiburg,
Faculty of Medicine, Freiburg im Breisgau, Germany; 2Department of
Human Sciences, Università degli Studi ‘Guglielmo Marconi’ Telematica,
Roma, Italy
Successful emotion regulation and good sleep quality represent major
core processes necessary for health maintenance. Consistently, their
alteration (i.e. emotion dysregulation and insomnia) have been linked
to increased vulnerability to psychopathology and health in general.
Empirical support is now available showing that sleep and emotional
processes interact dynamically to both behavioral and neurological
levels. Nevertheless, still little knowledge is available about the re-
ciprocal influences linking sleep impairment or presence of insomnia
disorder with individual's ability to regulate own emotions. In the
last 10 years, a number of narrative and systematic reviews summa-
rized the state-­of-­the-­art on what we currently know on the topic.
Preliminary results from an ecological momentary design study sug-
gest that patients with insomnia tend to report an excessive use of
different emotion regulation strategies compared to good sleepers
both in response to daily and nightly stressors. From a clinical point
of view, trials are available which showed the efficacy of cogni-
tive behavior therapy for insomnia in patients with depression and
anxiety. Furthermore, interventions targeting emotional regulatory
processes, as mindfulness training or Acceptance and Commitment
Therapy, have been evaluated in patients with insomnia with prelimi-
nary supportive results. It would be interesting to test the empirical
efficacy of interventions targeting both sleep and emotion regula-
tory processes in patients with mental disorders as new clinical
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trends supporting process-­based psychotherapy based on empirical
evidence for treatment of psychopathology.
Disclosure: Nothing to disclose.
O24 | Treating patients with insomnia and
depression
J. Lancee
University of Amsterdam, Amsterdam, The Netherlands
Insomnia and depression are highly related. Furthermore, having in-
somnia increases the chance of developing a depression. In recent
years several studies have investigated the beneficial effects of cog-
nitive behavioral therapy for insomnia (CBTI) on depressive symp-
toms. Overall the results of these studies are very promising with
effect sizes in the range of what is observed after traditional CBT for
depression. The problem however, is that most studies are carried
out in samples with subclinical depression. Another issue is that the
working mechanisms are still unclear and little is known about which
specific treatment components are effective.
In this round table I will argue that insomnia is an interesting tar-
get to treat depression. At the same time there is a need for high
disorder. These studies would need to focus beyond efficacy and
also include treatment mechanisms.
Disclosure: Nothing to disclose.
O R A L S E S S I O N 4 – S LE E P D E PR I VATI O N
O25 | Caffeine effectively counteracts
performance impairments during the first
2 days of chronic sleep restriction in genetically
caffeine-­sensitive individuals
E.-M. Elmenhorst1; D. Elmenhorst2; D. Lange1; D. Baur3; J.
Fronczek-Poncelet2; E. Hennecke1; A. Bauer2; H.-P. Landolt3;
D. Aeschbach1
1
Sleep and Human Factors Research, German Aerospace Center,
Cologne; 2Institute of Neuroscience and Medicine (INM-­2), Research
Center Jülich, Jülich, Germany; 3Institute of Pharmacology &
Toxicology, University of Zurich, Zurich, Switzerland
Objectives/Introduction: Caffeine is commonly trusted to counter-
act the performance impairing effects of sleep loss. However, the
knowledge on the day-­to-­day efficacy of caffeine in preserving op-
timal performance under conditions of chronic sleep restriction is
scarce. We investigated the efficacy of caffeine in individuals who
 |
14 of 356       ABSTRACTS
carry the C/C-­allele of the adenosine A 2A receptor (ADORA c.1976),
a genotype known to have a high caffeine-­sensitivity.
Methods: We examined 71 healthy volunteers aged 20–40 years in
the lab. After one adaptation and two baseline days with prior 8 h
time in bed (TIB) each, (1) the control group (CO, n = 15, 5 female)
had 8 h TIB for the following six nights, (2) the restriction group (RG,
n = 21, 9 female) had 5 days (E1 to E5) with prior 5 h TIB followed
by an recovery day (Rec) after 8 h TIB, (3) the caffeine group (Caff,
n = 19, 8 female) had the same schedule as the RG, but received
standardized 600 g coffee (∼300 mg caffeine) per day during E1 to
E4 and 400 g coffee (∼200 mg caffeine) on E5, (4) the decaff group
(Decaff, n = 16, 7 female) underwent the same schedule as the Caff,
but consumed decaffeinated coffee. The Caff and Decaff partici-
pants carried the caffeine-­sensitive genotype. Mixed ANOVAs with
Bonferroni adjusted α < 0.016 compared the impairment in partici-
pants’ mean daytime (at 2, 5, 11, and 15 h awake) speed (1/reaction
time) as difference to baseline on a 10-­min Psychomotor Vigilance
Task.
Results: Speed in the RG was impaired compared to the CO at E1 to
E5 (p < 0.009), but not at Rec (p = 0.103). In the Caff speed was faster
than in the Decaff at E1 (p = 0.014) and faster than in the RG at E1
and E2 (p < 0.002), but slower than in the CO at E3 to Rec (p < 0.014).
At 11 h awake, speed in the Decaff was faster than in the RG at E1
and E2, but slower than in the CO at E3 to E5 (p < 0.006).
Conclusions: Under chronic sleep restriction, ∼300 mg caffeine per
day kept performance at rested levels for 2 days. Decaffeinated
coffee also seemed to be beneficial. The use of caffeine delayed
recovery.
Disclosure: The work was supported by the Institute for Scientific
Information on Coffee, the Swiss National Science Foundation (#
320030_163439) and respective institutional funds from all contrib-
uting institutions.
O26 | Impact of chronic sleep restriction on A1
adenosine receptor availability
1,2 3 1
D. Lange ; J. Fronczek-Poncelet ; E. Hennecke ;
B. Neumaier4; A. Bauer3,5; D. Aeschbach1,6; E.-M.
Elmenhorst1,2; D. Elmenhorst3
1
Institute of Aerospace Medicine, German Aerospace Center, Cologne;
2
Institute of Occupational Medicine, RWTH Aachen University,
Aachen; 3Institute of Neuroscience and Medicine (INM-­2); 4Institute of
Neuroscience and Medicine (INM-­5), Forschungszentrum Jülich, Jülich;
5 impaired cognitive functioning and vigilance. However, the mecha-
Department of Neurology, Medical Faculty, Heinrich Heine University,
Düsseldorf, Germany; 6Division of Sleep Medicine, Harvard Medical
School, Boston, MA, United States
Objectives/Introduction: Adenosine, as a homeostatic sleep factor,
and its most abundant A1 adenosine receptor (A1AR) play an impor-
tant role in sleep-­wake regulation. Acute sleep deprivation leads to
an increase in deep sleep pressure which, on the molecular level, is
represented by an increase in A1AR availability in the human brain.
To date, it is unknown whether chronic sleep restriction, a condition
in which deep sleep is mostly preserved, is likewise regulated.
Methods: Thirty-­six healthy volunteers underwent two positron-­
emission-­tomography (PET) scans with the radioligand [18F]CPFPX
to quantify A1AR availability. The intervention group with 21 partici-
pants (mean age 25.9 ± 3.6 years, 9 females) underwent a first PET
scan after 5 days of chronic sleep restriction with 5 hours time in bed
(TIB) each. The second PET scan was performed after an 8 hours TIB
recovery night. The control group with 15 participants (mean age
27.5 ± 5.8 years, 5 females) had 8 hours TIB each night. The A1AR
availability is presented regarding the [18F]CPFPX binding potential
(BPND) calculated by Logan's reference tissue model (t* = 30 min)
with the cerebellum as reference region. Within-­and between-­
group effects were tested using paired and unpaired t-­tests.
Results: Recovery from sleep restriction did not indicate a significant
reduction in A1AR in the intervention group for all 13 grey matter
subdivided regions, e.g. striatum, hippocampus, Thalamus and oc-
cipital, temporal, and parietal lobe (all p > 0.06). Likewise, results
from the first (p > 0.22) and second scan (p > 0.05) did not differ
between groups.
Conclusions: The non-­significant change in cerebral A1 AR avail-
ability in recovery from 5 nights of chronic sleep restriction is
in line with the preserved deep sleep at that time and may indi-
cate that chronic and acute sleep deprivation are differentially
regulated.
Disclosure: Nothing to disclose.
O27 | The impact of sleep deprivation on
cortical functional integration and cognitive
performances
N. Cross1,2; F. Pomares1,2; A. Jegou1,3; A. Nguyen1; A.
Perrault1,2; D. Smith1; U. Aydin1,3; C. Grova1,3,4; T.T.
Dang-Vu1,2
1
PERFORM Centre, Concordia University; 2Centre de Recherche de
l'Institut Universitaire de Gériatrie de Montreal; 3Department of
Physics, Concordia University, Montréal; 4Department of Biomedical
Engineering, Neurology and Neurosurgery, McGill University, Montreal,
QC, Canada
Objectives/Introduction: Sleep deprivation (SD) is associated with
nisms underlying the impact of sleep deprivation on cognition re-
main unclear. Functional connectivity of brain activity during tasks
can provide insight into how the disruption of integration and segre-
gation of functional brain networks may impact cognition.
Methods: 20 healthy young adults (mean age = 21.15, 12 females)
were scanned using simultaneous EEG-­fMRI (256-­electrode EEG;
3T MRI) while performing three cognitive tasks during three condi-
tions: rested wakefulness (RW), following 24-­hrs total SD, and post
ABSTRACTS
a one-­hour recovery nap (PRN) opportunity. The cognitive tasks in-
cluded the Attention Network Task (ANT), N-­back task of working
memory, and the Psychomotor Vigilance Task (PVT). Functional time
series were extracted from 400 cortical regions and concatenated
across all tasks for every subject, which were then correlated be-
tween all regions. A hierarchical measure of integration within the
entire brain and for each of 17 functional brain networks was com-
puted in each condition. The change in integration from baseline to
SD for each subject was then correlated with the percentage of cor-
rect trials and mean reaction time for each task.
Results: There was a significant decrease in accuracy and increase
in reaction time from RW to SD, followed by a slight normalisation
at PRN on all tasks (F = 10.96–14.27, p = 0.001–0.007). There was a
widespread increase in the functional correlations between cortical
regions from RW to SD (47% of connections > t = 2; p < 0.05). This
was followed by a decrease in connectivity to a lesser extent from
the SD to post-­nap (16.7% > t = 2; p < 0.05). Similarly, total brain in-
tegration increased during SD and then decreased following the nap.
The increase in integration was negatively correlated with change
in accuracy from RW to SD on the ANT (r = −0.83, p < 0.001) and
N-­back (r = −0.66, p = 0.002) tasks, but not the PVT. The change in
total integration was also positively correlated with change in mean
reaction time during the N-­back task (r = 0.68, p < 0.001).
Conclusions: These findings suggest that sleep regulates the levels
of integration and segregation of brain networks during wakeful-
ness, which impacts the individual's ability to maintain optimal per-
formances during cognitive tasks.
Disclosure: Nothing to disclose.
O28 | Closed-­loop acoustic neurostimulation
during sleep: induction of slow oscillations
to increase sleep stability in the presence of
environmental noise
V. Pathak1; E. Juan1; D. Koller2; R. van der Goot1; L. Talamini1
1
Sleep and Memory laboratory, Brain and Cognition Group, Department
of Psychology, University of Amsterdam, Amsterdam; 2ESTEC,
European Space Agency, Noordwijk, The Netherlands
Objectives/Introduction: Sleep is critical for good health and well-­
being. However, sleep disruption due to noise is a growing problem,
not only for the general public but also for astronauts during space
flight. Here, for the first time, we tested a non-­invasive, potential
countermeasure for sleep disruptions due to noise.
Methods: We used a closed-­loop acoustic neurostimulation (CLNS)
system, developed in-­house, to boost slow oscillations (SO) during
Non-­Rapid eye movement (NREM) sleep. Nine healthy participants
(5 female; aged 20 ± 1.7 years) underwent 3 nights of polysom-
nography and high-­density EEG recordings in the lab:(1) a baseline
night, (2) a night with repeated presentation of sleep-­
disrupting
sounds (‘disrupting condition’, DC) and (3) a night where, in addition
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      15 of 356
to sleep-­disturbing sounds, short clicks phased-­locked to the start
of the SO up-­phase were presented to enhance SO (‘boosting con-
dition’, BC). Sleep-­disturbing sounds lasted 10 seconds, were pre-
sented between 40 and 70 dB according to individual sub-­arousal
thresholds, and included everyday noises, such as a plane taking off
or people talking. All experimental manipulations were performed in
the first three hours of the night, during NREM sleep stage 3; partici-
pants slept undisturbed for the rest of the night.
Results: In comparison to sleeping in noisy conditions (DC), sleeping
in noisy conditions with SO boosting (BC) significantly reduced the
number of arousals (8.7 ± 3 and 4.3 ± 2.4 respectively; t(8) = −3.62,
p = 0.003). The time spent in NREM sleep was also significantly
longer in BC as compared to DC (130.7 ± 14.6 and 110.11 ± 24.25 re-
spectively ; t(8) = 2.35; p = 0.046). Interestingly, these experimental
manipulations limited to the first part of the night impacted the sleep
architecture of the whole night: the time spent in NREM sleep was
longer in BC as compared to DC when considering the entire night
(397.7 ± 58.6 and 350.9 ± 59.5; t(8) = 2.86, p = 0.021).
Conclusions: These results suggest that enhancement of SO using
phase-­locked acoustic stimulation during NREM sleep can effectively
deepen and stabilise sleep in the presence of noise. Furthermore,
boosting SO seems to have an effect beyond the targeted period.
Together, these findings pave the way towards a new, low-­cost and
non-­invasive sleep protective method safe to use for astronauts and
in the general population.
Disclosure: Nothing to disclose.
O29 | Behavioral and neural correlates of
emotional facial expressions stimuli processing
in adults with ADHD before and after sleep
deprivation: an ERP study
O. Dan1; A. Harel2; K. Asraf2; J. Saveliev2; A. Cohen2; I.
Haimov2
1
Psychology; 2The Max Stern Academic College of Emek Yezreel, Emek
Yeezreel, Israel
Objectives/Introduction: This study sought to examine effects of
sleep deprivation on the processing of emotional facial expressions
in individuals with or without attention deficit hyperactivity disor-
der (ADHD). We hypothesized that extended sleep deprivation will
hinder the processing of emotional facial expressions in both the
behavior and the neural levels, an effect that will be greater among
individuals diagnosed with ADHD than among individuals without
such a diagnosis.
Methods: Twenty eight young men (M = 25.6) with (n = 14) or without
(n = 14) a diagnosis of ADHD were included in this study. The par-
ticipants were instructed to sleep 7 h or more each night for 1 week
(monitored via actigraph). During the subsequent experimental ses-
sion, behavioral and event-­related potential (ERP) responses were
examined using a visual oddball task, combining facial and nonfacial
 |
16 of 356       ABSTRACTS
stimuli, before and after 26 hours of sleep deprivation. Responses to
target and nontarget stimuli were compared across groups of young
adults with or without ADHD.
Results: At the behavior level, a significant Time × ADHD interac-
tion was found for emotional facial stimuli omissions [F (1, 26) = 6.31,
p = 0.02]. At the onset of the experiment there were no differences
in omission errors between the participants with ADHD and those
without ADHD. Following sleep deprivation, however, the ADHD
group had more omission errors compared with the control group.
At the Neural level a main effect for group was found across all the
components (P1, N1, P2, N2, P3 and LPP). In addition, a significant
Time × ADHD x Stimuli interaction was found on P3 for emotional
facial stimuli [F (1, 25) = 4.18, p = 0.049].
Conclusions: Among young adults with ADHD, sleep deprivation
may hinder the processing of facial stimuli. Moreover, the current
results suggest that the neuronal processes involved in the process-
ing of emotional facial expressions, and their sensitivity to sleep
deprivation, differ in young adults with ADHD compared to young
adults without ADHD.
Disclosure: Nothing to disclose.
O30 | Neurobehavioural functions during
variable and stable short sleep schedules
T.B. Koa; J. Lo
Centre for Sleep and Cognition and Department of Medicine, National
University of Singapore, Kent Ridge, Singapore
Objectives/Introduction: Many individuals extend their sleep on
free days to compensate for their restricted sleep opportunities on
school/work days. Here, we investigated whether such a variable
sleep schedule might mitigate the sleep loss-­induced neurobehav-
ioural deficits relative to a stable short sleep schedule.
Methods: In this four-­
night experiment, 78 young adults (mean
age ± SD: 21.77 ± 2.19 years) were randomly assigned to the 8888,
8666, 8846 and 8486 groups, where each digit corresponded to
the time-­in-­bed (TIB) in each study night. After one baseline night
of 8-­h TIB, TIB remained unchanged for the 8888 group, while the
other three groups had short sleep schedules that all summed up
to 18 hours of TIB but differed in the number of changes in TIB.
Sustained attention (Psychomotor Vigilance Task [PVT]), speed of
processing (Mental Arithmetic Task [MAT]), and subjective sleepi-
ness (Karolinska Sleepiness Scale [KSS]) were assessed after the
baseline night and the three manipulation nights.
Results: The group x day interactions for PVT mean speed and
median reaction time (p < 0.001) were significant: the 8888 group
responded faster after the manipulation period (p = 0.01), while in-
dividuals adopting the less variable sleep schedules (i.e. the 8666
and 8846 groups) became slower (p < 0.01), and interestingly, the
most variable sleep schedule (8486) did not lead to such decre-
ment (p = 0.14). Also, although the group x day interaction was not
significant for the accuracy measure in the MAT (p = 0.31), signifi-
cant improvement in processing speed was found in the well-­rested
participants (8888; p = 0.001) and those with variable short sleep
schedules (8846 and 8486; p < 0.009), but not in those who had a
stable short sleep schedule (8666; p = 0.09). Furthermore, the group
x day interaction for KSS score was significant (p = 0.049): subjective
sleepiness was elevated in the 8666 and the 8846 groups (p < 0.05),
but was preserved in the 8888 and importantly, the 8486 groups
(p > 0.05).
Conclusions: When sleep opportunities across multiple nights are
limited, adopting a variable sleep schedule may help attenuate some
of the neurobehavioural deficits associated with recurrent sleep loss.
Disclosure: Nothing to disclose.
O31 | The effect of sleep deprivation on task
performance, mind wandering and sleepiness in
young and older adults
J. Schwarz1; A. Gerhardsson1,2; W.M.A. Van Leeuwen1;
M. Lekander1; H. Fischer2; J. Axelsson1; G. Kecklund1; T.
Åkerstedt1
1
Department of Psychology, Stress Research Institute; 2Department of
Psychology, Stockholm University, Stockholm, Sweden
Objectives/Introduction: Mind wandering, the drift of attention
from the task at hand to task-­unrelated thoughts (TUTs), is usually
associated with poorer performance, and could thus be a potential
pathway through which sleep deprivation impairs performance. Our
aim was to investigate the effect of sleep deprivation on perfor-
mance and TUTs in a sustained attention to response task (SART),
and on sleepiness. Since older individuals are less prone to TUTs and
less affected by sleep deprivation, we studied also whether age is a
moderator.
Methods: Healthy young (18–30 years) and older adults (60–
72 years) participated after either normal night sleep (NSD) or sleep
deprivation (SD): NSDyoung (n = 31), SDyoung (n = 30), NSDold
(n = 24), SDold (n = 24). Performance was measured using the SART,
which included 10 thought probes that prompted participants to in-
dicate what they were thinking about, using predefined answer al-
ternatives. Mind wandering was quantified as occurrence of TUTs.
Sleepiness was rated using the Karolinska Sleepiness Scale (KSS).
Data analysis comprised 2 × 2 ANOVAs.
Results: Main effects for sleep deprivation and age were significant
for omission errors, indicating worse performance after sleep dep-
rivation and in young participants (p's < 0.05). These main effects
were dominated by an age*sleep deprivation interaction (p < 0.05);
sleep deprivation caused more omissions in young (Mean±SEM;
NSDyoung: 2.3 ± 0.9; SDyoung: 13.1 ± 4.1) but not in older partici-
pants (NSDold: 1.9 ± 0.4; SDold: 2.8 ± 0.9). Likewise, main and inter-
action effects were significant for TUTs (p's < 0.05). TUTs were more
frequent after sleep deprivation in young (NSDyoung: 1.5 ± 0.2;
ABSTRACTS
SDyoung: 4.3 ± 0.6), but not in older participants (NSDold: 0.3 ± 0.2;
SDold: 0.5 ± 0.2) (age*sleep deprivation p < 0.05). Regardless of sleep
condition, young participants had more TUTs. Sleepiness was sig-
nificantly higher in young participants and after sleep deprivation,
but without a significant age*sleep deprivation interaction (KSS
NSDyoung: 3.6 ± 0.2; SDyoung: 6.9 ± 0.4; NSDold: 3 ± 0.2; SDold:
5.7 ± 0.4).
Conclusions: The results show that sleep deprivation was related to
both TUTs and poorer performance in young but not in older partici-
pants. On the other hand, age did not moderate the effect of sleep
deprivation on sleepiness. The results may indicate that a diminished
ability to shut down TUTs could be a pathway to performance decre-
ments after sleep loss, particularly so in young adults.
Disclosure: This study was funded by the Riksbankens Jubileumsfond.
EU RO PE A N N E T WO R K S E S S I O N : I N S O M N I A
O32 | Predicting, preventing and alleviating
depression: network analyses point to the
primary importance of insomnia
T. Blanken1,2; T. Van der Zweerde3; D. Borsboom2; J.
Lancee 4; A. Van Straten3; B.W.J.H. Penninx5; E.J.W. Van
Someren1,5,6
1
Sleep and Cognition, Netherlands Institute for Neuroscience, an
Institute of the Royal Netherlands Society for Arts and Sciences;
2
Psychological Methods, University of Amsterdam; 3Clinical
Psychology, VU University; 4Clinical Psychology, University
of Amsterdam; 5Psychiatry, Amsterdam Neuroscience, VU
University Medical Center; 6Integrative Neurophysiology, Center
for Neurogenomics and Cognitive Research (CNCR), VU University
Amsterdam, Amsterdam, The Netherlands
Background: Insomnia is the second-­most prevalent disorder and a
primary risk factor for depression. It has proven difficult, however,
to pinpoint consistent characteristics of insomnia, suggesting un-
recognized heterogeneity. In addition, considerable overlap in the
symptoms of insomnia and depression raises questions on their em-
pirically identified relationships: could the increased risk and their
co-­occurrence largely reflect this symptom overlap? In a series of
studies we aimed to unravel insomnia heterogeneity and disentangle
the relationship between insomnia and depression.
Methods: First, in an observational study, we performed latent class
analysis on N = 2224 participants with insomnia for a data-­driven
identification of subtypes. Second, in a 6-­year prospective study
in N = 768 participants free from lifetime depression, we investi-
gated the role of insomnia symptoms among other primary risk fac-
tors for de novo depression onset. Third, in an intervention study
in N = 104 participants with co-­occurring insomnia and depression
symptoms we investigated sequential and specific treatment effects
|
      17 of 356
of cognitive behavioural therapy for insomnia (CBTI). In these final
two studies we introduced novel network analyses approaches to
disentangle primary versus secondary factors.
Results: First, we identified five insomnia subtypes that were distin-
guished by their multivariate profile of life history, affect and per-
sonality and that, crucially, differed up to a factor five in their risk of
comorbid and lifetime depression. Second, we identified specifically
difficulty initiating sleep (DIS) as a risk factor for first-­onset depres-
sion, even after accounting for all other depression-­related com-
plaints. Third, we demonstrated that the improvement of depression
by CBTI was preceded by CBTI effects on specific sleep complaints,
notably difficulty maintaining sleep (DMS) and early morning awak-
ening (EMA).
Discussion: The identification of DIS and specific insomnia subtypes
as primary threats for the development of depression now allows,
for the first time, to select patients with the highest risk and opens
up ways for prevention of depression. People with concurrent de-
pression and insomnia complaints can benefit from insomnia treat-
ment targeting EMA and DIS. Together, these studies point towards
the key role for specific insomnia symptoms in the development and
treatment of depression, offering opportunities to combat the global
burden of disease through prevention and intervention.
Disclosure: Nothing to disclose.
O R A L 5 – N EU RO LO G Y & H Y PE R S O M N I A &
M OV E M E NT D I S O R D E R S & PA R A S O M N I A S
O33 | Video-­polysomnographic assessment for
the diagnosis of disorders of arousal in children
R. Lopez1,2; C. Laganière3,4; S. Chenini1; A.L. Rassu1; E.
Evangelista1,2; L. Barateau1,2; I. Jaussent2; Y. Dauvilliers1,2
1
Centre National de Référence Narcolepsie Hypersomnies, Unité
des Troubles du Sommeil, Service de Neurologie, Hôpital Gui-­de-­
Chauliac; 2PSNREC, Univ Montpellier, INSERM, Montpellier, France;
3
Department of Educational and Counselling Psychology, McGill
University; 4Hôpital en Santé Mentale Rivière-­des-­Prairies, CIUSSS-­du-­
Nord-­de-­l’île-­de-­Montréal, Montreal, QC, Canada
Objectives/Introduction: To assess video-­polysomnographic (vPSG)
criteria and related cut-­off values for the diagnosis of disorders of
arousal (DOA) in children, biomarkers already validated in adults
with DOA.
Methods: One hundred children with frequent episodes of DOA and
50 sex-­and age-­matched non-­parasomniac children underwent a
vPSG recording to quantify slow wave sleep (SWS) alterations (num-
ber of N3 sleep interruptions, SWS fragmentation index; slow/mixed
and fast arousal ratios and indexes per hour) and the associated be-
haviors. We compared the SWS alterations in the two groups and
 |
18 of 356       ABSTRACTS
defined the optimal cut-­off values for the diagnosis of DOA using the
receiver operating characteristics curves.
Results: Patients with DOA had higher N3 and REM sleep, number
of N3 interruptions, SWS fragmentation and slow/mixed arousal in-
dexes than controls. The highest area under the curve (AUC) val-
ues were obtained for SWS fragmentation and slow/mixed arousal
indexes with satisfactory classification performances (AUC 0.80;
95% CI 0.73–0.87 and AUC 0.82; 95% CI 0.75–0.89). SWS fragmen-
tation index cut-­off value of 4.1/h reached a sensitivity of 65.0%
and a specificity of 84.0%. Slow/mixed arousal index cutoff of 3.8/h
reached a sensitivity of 69.0% and a specificity of 82.0%. At least
one parasomniac episode was recorded in 63.0% of patients and
none of the controls. Combining behavioral component by vPSG in-
creased sensitivity of both biomarkers to 83% and 89%, respectively.
Conclusions: We confirmed that SWS fragmentation and slow/
mixed SWS arousal indexes are two relevant biomarkers for the
diagnosis of DOA in children, with different cutoffs obtained than
those validated in adults.
Disclosure: Nothing to disclose.
O34 | A brain signature of prodromal Lewy
body dementia in isolated REM sleep behavior
disorder
S. Rahayel1,2; R. Postuma2,3; J. Montplaisir2,4; B. Mišić1;
C. Tremblay1; A. Vo1; S. Lewis5; E. Matar5; K. Ehgoetz
Martens5,6; F. Blanc7; C. Yao1; A. Pelletier2,3; M. Gaubert2; J.
Carrier2,8,9; O. Monchi10,11; S. Chouinard12; M. Panisset12; A.
Dagher1; J.-F. Gagnon2,9,13
1
Montreal Neurological Institute and Hospital, McGill University;
2
Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-­
Coeur de Montréal; 3Department of Neurology, Montreal General
Hospital; 4Department of Psychiatry, Université de Montréal,
Montreal, QC, Canada; 5ForeFront Parkinson's Disease Research
Clinic, Brain and Mind Centre, University of Sydney, Camperdown,
NSW, Australia; 6Department of Kinesiology, University of Waterloo,
Waterloo, ON, Canada; 7ICube Laboratory and FMTS (Fédération de
Médecine Translationnelle de Strasbourg), Team IMIS, Université de
Strasbourg and CNRS, and University Hospital of Strasbourg, CM2R
(Memory Resource and Research Centre), Day Hospital, Geriatrics
Department, Strasbourg, France; 8Department of Psychology,
Université de Montréal; 9Research Centre, Institut universitaire
10
de gériatrie de Montréal, Montreal, QC; Departments of Clinical
Neurosciences, Radiology, and Hotchkiss Brain Institute, University of
11
Calgary; Department of Radiology, Radio-­Oncology, and Nuclear
12
Medicine, Université de Montréal, Calgary, AB; Unité des Troubles
du Mouvement André-­Barbeau, Centre Hospitalier de l'Université
13
de Montréal; Department of Psychology, Université du Québec à
Montréal, Montreal, QC, Canada
Objectives/Introduction: Isolated rapid eye movement sleep behav-
ior disorder (iRBD) is a prodromal stage of a synucleinopathy, such as
dementia with Lewy bodies (DLB), Parkinson's disease (PD), and multi-
ple system atrophy (MSA). The clinical features of iRBD include cogni-
tive, motor, autonomic, and neuropsychiatric impairments; structural
brain changes have been reported but are inconsistent. In this study,
we sought to determine the brain-­clinical signature of iRBD and if its
expression predicted the development of dementia in these patients.
Methods: Forty-­
eight iRBD patients underwent polysomnography,
neurological and neuropsychological assessments, and brain MRI. Brain
tissue deformation was measured using deformation-­based morphom-
etry in CAT12 and standardized to 41 matched healthy controls. Clinical
variables included 27 measures assessing cognitive, motor, sleep, auto-
nomic, and neuropsychiatric features. Partial least squares correlation
was used to derive latent variables that maximized covariance between
brain and clinical features. Logistic regressions were used to study if
the pattern was associated with conversion to DLB in 76 iRBD patients
followed longitudinally. The pattern of expression was studied in inde-
pendent cohorts of 207 patients with an overt synucleinopathy (i.e.,
DLB, mild neurocognitive disorder with Lewy bodies or PD).
Results: In the 48 iRBD patients, one latent variable explained 31.1%
of the covariance between tissue deformation and clinical features
(p < 0.001). Cognitive and motor features, especially mild cogni-
tive impairment and UPDRS-­III, were the main clinical contributors,
whereas contraction in the basal ganglia, midbrain, and white mat-
ter, and expansion of the ventricular system, were the main brain
contributors. In the iRBD patients followed longitudinally, 18 (24%)
developed a synucleinopathy: PD in 10, DLB in 7, and MSA in 1. The
deformation score of the pattern predicted conversion to DLB in
iRBD (p = 0.007). Deformation score was higher in iRBD patients
who developed DLB compared to PD patients (p < 0.001), but similar
to that of patients with DLB (p = 0.10) or mild neurocognitive disor-
der with Lewy bodies (p = 0.28).
Conclusions: Using longitudinal and cross-­sectional data, we identi-
fied a brain signature associated with conversion to DLB in iRBD.
This will be useful for the early identification of patients at risk in
order to optimize patient care, target risk reduction strategies, and
eventually administer neuroprotective trials.
Disclosure: Funding: This work was supported by the Canadian
Institutes of Health Research (CIHR), the Fonds de recherche du
Québec – Santé (FRQS), and the W. Garfield Weston Foundation. A
NHMRC Dementia Team Grant (#1095127) supported work performed
at the University of Sydney. The Appel à Projet Interne (API) of the
University Hospital of Strasbourg, Alsace Alzheimer 67, the Fondation
Université de Strasbourg and Ag2R la Mondiale, and by the Projet
Hospitalier de Recherche Clinique (PHRC) inter-­régional supported
work performed in Strasbourg. Disclosures: Dr. Rahayel is supported
by a postdoctoral scholarship from the FRQS. Dr. Postuma reports
grants and personal fees from FRQS, grants from CIHR, The Parkinson
Society of Canada, Weston Garfield Foundation, Michael J. Fox
Foundation, Webster Foundation, personal fees from Takeda, Roche/
Prothena, Teva Neurosciences, Novartis Canada, Biogen, Boehringer
Ingelheim, Theranexus, GE HealthCare, Jazz Pharmaceuticals, Abbvie,
ABSTRACTS
Jannsen, Otsuko, Phytopharmics, Inception Sciences, and others from
Parkinson Canada not related to the submitted work. Dr. Matar is sup-
ported by a NHMRC Postgraduate Scholarship and an ANZAN E+RF
Gwen James Research Grant. Dr. Lewis is supported by a NHMRC-­
ARC Dementia Fellowship (#1110414). Dr. Carrier reports grants
from Canopy Health, Rana, Merck, Philips/Respironics, and Canopy
Growth/Spectrum, not related to the submitted work. Dr. Gagnon re-
ports grants from W. Garfield Weston Foundation, CIHR, and Canada
Research Chair during the period the study was conducted. All other
authors report no relevant conflicts of interest for the submitted work.
O35 | Dopamine transporter neuroimaging
and clinical predictors for phenoconversion of
idiopathic REM sleep behavior disorder to overt
synucleinopathy: an international multicenter
study
D. Arnaldi1,2; A. Chincarini3; M. Hu4; K. Sonka5; B. Boeve6;
T. Miyamoto7; M. Puligheddu8; V. Cochen De Cock9; M.
Terzaghi10; G. Plazzi11; N. Tachibana12; S. Morbeli13; M.
Rolinski14; P. Dusek5; V. Lowe6; M. Miyamoto15; M. Figorilli8;
D. de Verbizier9; I. Bossert16; E. Antelmi11; R. Meli13; T.
Barber4; J. Trnka5; T. Miyagawa6; A. Serra8; M. Bauckneht2;
K. Bradley17; D. Zogala5; D. McGowan17; F. Pizza11; J.
Lennon6; R. Manni18; F. Nobili13
1
DINOGMI, University of Genoa; 2IRCCS Ospedale Policlinico San
3 4
Martino; National Institute of Nuclear Physics, Genoa, Italy; University
5
of Oxford, Oxford, United Kingdom; Charles University and General
University Hospital, Prague, Czech Republic; 6Mayo Clinic and
Foundation, Rochester, MN, United States; 7Dokkyo Medical University
Saitama Medical Center, Saitama, Japan; 8University of Cagliari, Cagliari,
Italy; 9Montpellier University Hospital, Montpellier, France; 10
11
of Pavia/IRCCS Mondino Foundation, Pavia; University of Bologna,
12
IRCCS Institute of Neurological Sciences, Bologna, Italy; Kansai Electric
13
Power Medical Research Institute, Osaka, Japan; University of Genoa,
14
Genoa, Italy; University of Bristol, Bristol, United Kingdom;
16
Medical University Hospital, Tochigi, Japan; ICS Maugeri SpA SB IRCCS,
17 18
Pavia, Italy; Churchill Hospital, Oxford, United Kingdom;
Mondino Foundation, Pavia, Italy
Objectives/Introduction: This is an international multicenter study
aimed at evaluating the combined value of dopaminergic neuroimag-
ing and clinical features in predicting future phenoconversion of idio-
pathic REM sleep behavior (iRBD) subjects to Parkinson's Disease (PD),
Dementia with Lewy bodies (DLB) or Multiple system atrophy (MSA).
123
Methods: Nine centers worldwide sent I-­FP-­CIT-­SPECT data
of 344 iRBD patients and 256 controls for centralized analysis.
123
I-­
FP-­
CIT-­
SPECT images were semi-­
quantified using DaTQUANT™
(GE Healthcare), obtaining bilateral putamen and caudate specific to
non-­displaceable binding ratios (SBRs), using the occipital lobes as the
|
      19 of 356
reference region. The following clinical variables were also analyzed:
(i) Movement Disorder Society-­
sponsored revision of the unified
Parkinson's disease rating scale, motor section (MDS-­UPDRS-­III) score;
(ii) Mini-­Mental state examination (MMSE) score; (iii) constipation; (iv) hy-
posmia. Kaplan-­Meier survival analysis was performed to estimate con-
version risk. Hazard ratios (HR) for each variable were calculated with
Cox regression. A generalized logistic regression model was applied to
identify the best combination of risk factors. Bayesian classifier was used
to identify the baseline features predicting conversion to PD or to DLB.
Results: After data quality check, 263 iRBD patients (67.6 ± 7.3 years,
229 males) and 243 controls (67.2 ± 10.1 years, 110 males) were ana-
lyzed. Fifty-­t wo (20%) patients develop a synucleinopathy over an
average follow-­up time of 2 years (33 PD, 18 DLB and 1 MSA). On
Cox proportional hazards analysis, most variables significantly pre-
dicted outcome. The best combination of risk factors was putami-
nal dopaminergic dysfunction on the most affected hemisphere,
defined as the minimum value between left and right putamen
(p < 0.000001); constipation, (p < 0.000001) and age over 70 years
(p = 0.0002). Combined features obtained from the generalized lo-
gistic regression achieved an HR of 5.71 (95% confidence interval
2.85–11.43). Bayesian classifier suggested that patients with higher
MMSE score and lower Caudate asymmetry were more likely to
develop PD, while patients with lower MMSE and higher Caudate
asymmetry were more likely to develop DLB.
Conclusions: This study shows that iRBD patients over 70 years of
age with constipation and reduced nigro-­putaminal dopaminergic
function are at high risk of short-­term phenoconversion to an overt
synucleinopathy, providing an effective stratification approach for
future neuroprotective trials.
Disclosure: Nothing to disclose.
O36 | Do sleep homeostasis influence bedtime
University
to morning-­on-­waking mobility in Parkinsonʼs
disease? A quantitative EEG study
15 T. Aumont1; P.-E. Nunes-Ferreira2; J.-M. Lina1; F. Faraci3; M.
Dokkyo
Dramé 4; A. Puiatti3; A. Kaelin-Lang2; J. Carrier5; P.-L. Ratti2,6
1
Center for Advanced Research on Sleep Medicine (CEAMS), Hôpital
IRCCS
du Sacré-­Coeur de Montréal, Montréal, QC, Canada; 2Neurocenter
of Southern Switzerland, Lugano; 3Department of Innovative
Technologies, University of Applied Sciences and Arts of Southern
Switzerland, Manno, Switzerland; 4Methodology for Clinical Research
Unit, University Hospital of Martinique, Fort-­de-­France, Martinique;
5
Center for Advanced Research on Sleep Medicine (CEAMS), Hôpital
du Sacré-­Coeur de Montréal, Montréal, QC, Canada; 6Department of
Neurology, ULSS 3 Serenissima, dell'Angelo Hospital, Venice, Italy
Objectives/Introduction: A substantial proportion of patients with
Parkinson's disease (PD) report prominent, spontaneous, transitory bed-
time to morning-­on-­waking mobility improvement, before the first med-
ication intake of the day. This phenomenon is known as ‘sleep benefit’.
 |
20 of 356       ABSTRACTS
As the restorative effect of sleep mainly depends on the dissipation
of the sleep homeostatic process, we hypothesize that sleep ben-
efit might be associated with the nocturnal decay rate of Slow Wave
Activity (SWA, 1–5 Hz frequency band).
Methods: Motor performance was assessed at bedtime and 30 min-
utes after morning awakening in 26 PD patients undergoing 2 full-­
night video-­polysomnographies. The Movement Disorders Society
Unified Parkinson's Disease Rating Scale motor part (MDS-­UPDRS-­
III) was employed. The metrics of motor performance were: global
spontaneity of movement perceived by the examiner (question
3.14), MDS-­UPDRS-­III total score, single MDS-­UPDRS-­III motor fac-
tors (axial signs, rest tremor, rigidity, right hand dexterity, left hand
dexterity, postural and kinetic tremor, lower limbs agility).
The mean value of SWA in C3 and C4 within each 30-­s epoch of
sleep was expressed as the percentage of all-­night SWA. The slope
of SWA decay was calculated from an exponential decay function
fitted to the data after manual artifact rejection. Kendall's tau was
adopted for evaluating the association between SWA decay rate and
bedtime to morning-­on-­waking motor change.
Results: Thirty-­four video-­polysomnographic recordings obtained
from 21 patients (5 females, 68.1 ± 9.4 year-­old) were exploitable.
Among the patients treated with extended release dopaminergics
(n = 17), a strong association was found between the slope of SWA
decay and bedtime-­to-­morning improvement in global spontaneity
of movement perceived by the examiner (tau = −0.68, p = 0.0009).
Among MDS-­UPDRS-­III motor factors, a faster SWA decay was as-
sociated with an improvement in axial signs (tau = −0.66, p = 0.0006)
but not with the other factors. The slope of SWA decay was not as-
sociated with MDS-­UPDRS-­III total score.
No association was found in the group of patients treated with
standard release dopaminergics (n = 4).
Conclusions: The dissipation rate of sleep homeostatic pressure may
explain the clinically observed motor performance improvement on
axial signs (speech, posture, gait and equilibrium) in PD patients.
Disclosure: Nothing to disclose.
O37 | Cataplexy-­free days in a phase 3,
placebo-­controlled, double-­blind, randomised
withdrawal study of JZP-­258 in adults with
narcolepsy with cataplexy
Y. Dauvilliers1,2; N. Foldvary-Schaefer3; R.K. Bogan4; K.
Šonka5; J. Profant6; L. Huang6; M.J. Thorpy7
1
Department of Neurology, Sleep and Wake Disorders Centre, Gui
de Chauliac Hospital; 2University of Montpellier, INSERM U1061,
Montpellier, France; 3Cleveland Clinic Lerner College of Medicine,
Cleveland, OH; 4University of South Carolina School of Medicine,
Columbia, SC, United States; 5First Faculty of Medicine, Charles
University and General University Hospital, Prague, Czech Republic;
6
Jazz Pharmaceuticals, Inc., Palo Alto, CA; 7Albert Einstein College of
Medicine, Bronx, NY, United States
Objectives/Introduction: Sodium oxybate (SXB) is a standard of care
for the treatment of cataplexy and excessive daytime sleepiness in
patients with narcolepsy. JZP-­258 is a novel oxybate product candi-
date with 92% less sodium. This analysis evaluated cataplexy-­free
days/week in a placebo-­controlled randomised withdrawal study of
JZP-­258 treatment in patients with narcolepsy.
Methods: Treatment for cataplexy at study entry included 1)
SXB (SXB-­
only); 2) SXB plus other anticataplectics (SXB+other);
3) anticataplectics other than SXB (other anticataplectics); or 4)
anticataplectic-­naive. Participants (aged 18–70 years with narco-
lepsy with cataplexy) began JZP-­258 treatment during a 12-­week,
open-­label, optimised treatment and titration period (OLOTTP), fol-
lowed by a 2-­week stable-­dose period (SDP). Participants were ran-
domised to receive placebo or continue JZP-­258 treatment during a
2-­week, double-­blind, randomised withdrawal period (DBRWP).
Results: Of 201 enrolled participants, 134 were randomised (ef-
ficacy population; placebo, n = 65; JZP-­258, n = 69). Median (Q1,
Q3) cataplexy-­free days/week at first week of OLOTTP (while ini-
tiating JZP-­258) by prior treatment were SXB-­only, 5.8 (2.0, 7.0);
SXB+other, 6.4 (5.0, 7.0); other anticataplectics, 4.0 (1.8, 6.0);
anticataplectic-­naive, 3.5 (0, 5.8). At end of SDP (on stable dose of
JZP-­258), median (Q1, Q3) cataplexy-­free days/week were 6.0 (3.5,
7.0), 6.1 (1.4, 7.0), 6.0 (2.6, 7.0), and 6.2 (4.0, 7.0), respectively. At end
of SDP, prior to randomisation, there was no difference in median
cataplexy-­free days/week between participants to be randomised
to placebo (6.0 [3.5, 7.0]) or JZP-­258 treatment (6.0 [3.0, 7.0]); dur-
ing DBRWP, median cataplexy-­free days/week decreased in partici-
pants randomised to placebo (3.5 [0, 5.83]) but remained similar in
participants randomised to continue JZP-­258 treatment (5.6 [2.8,
7.0]). The overall safety profile of JZP-­258 was similar to SXB.
Conclusions: Cataplexy-­free days/week were higher during week 1
of OLOTTP in participants taking SXB at study entry compared with
those not taking SXB, and were similar in all groups at end of SDP.
Cataplexy-­free days/week were stable throughout OLOTTP in SXB-­
only participants and increased during OLOTTP in anticataplectic-­
naive participants. In SXB+other and other anticataplectics
participants, changes in cataplexy-­
free days/week corresponded
with taper and discontinuation of other anticataplectics during
OLOTTP. Cataplexy-­free days/week decreased in participants ran-
domised to placebo compared with those randomised to JZP-­258.
Disclosure: Support: Jazz Pharmaceuticals. Y Dauvilliers is a
consultant for and has participated in advisory boards for Jazz
Pharmaceuticals, UCB Pharma, Flamel Technologies, Theranexus,
and Bioprojet. N Foldvary-­Schaefer has served on an advisory com-
mittee for Jazz Pharmaceuticals and participated in clinical trials sup-
ported by Jazz Pharmaceuticals, Suven, and Takeda. RK Bogan has
served on the speakers’ bureau and participated in advisory boards
for Jazz Pharmaceuticals and Harmony Biosciences. K Šonka has
served on the speakers’ bureau for Sanofi, Angelini, and Stada and
participated in advisory boards for UCB and in clinical trials for Jazz
Pharmaceuticals, Flamel-­
Avadel, and Luitpold Pharmaceuticals. J
Profant and L Huang are full-­time employees of Jazz Pharmaceuticals
who, in the course of this employment, have received stock options
ABSTRACTS
exercisable for, and other stock awards of, ordinary shares of Jazz
Pharmaceuticals, plc. MJ Thorpy has received research/grant sup-
port and consultancy fees from Jazz Pharmaceuticals, Harmony
Biosciences, Balance Therapeutics, Axsome Therapeutics, and
Avadel Pharmaceuticals.
O38 | Effect of treatment on cognitive and
attention problems in children with narcolepsy
type 1
1 2 3 3
K. Janssens ; L. Quaedackers ; G.J. Lammers ; P. Amesz ;
P. van Mierlo3; L. Aarts2; E. Peeters4; D. Hendriks5; N.
Vandenbussche2; S. Overeem2; S. Pillen2
1
Sleep-­Wake Centre Stichting Epilepsie Instelling Nederland, Zwolle;
2 3
Kempenhaeghe, Heeze; Sleep-­Wake Centre Stichting Epilepsie
Instelling Nederland, Heemstede; 4Juliana Children's Hospital;
5
Sleeping Center, Medical Centre Haaglanden, The Hague, The
Netherlands
Objectives/Introduction: To ascertain the presence of cognitive
and attention problems in treatment naïve children with narcolepsy
type 1 (NT1) and to explore whether children recently diagnosed
with NT1 improve with respect to cognition and attention problems
1 year after regular treatment for NT1.
Methods: Fifteen treatment naïve children (7–15 years) with recently
diagnosed NT1 were recruited from three sleep medicine centers in
the Netherlands. The control group consisted of 15 healthy children,
being frequency matched on age and gender. Both groups were in-
vestigated at baseline to examine intelligence profile (WISC III), at-
tention problems and processing speed (Bourdon Vos and SART).
These tests were repeated in children with NT1 1 year after regular
(behavioral and medication) treatment for NT1.
Results: Children with NT1 scored significantly lower on the verbal
scale and processing speed subscale of the WISC III, showed more
fluctuations in reaction time of the Bourdon Vos and made more
mistakes during the SART than the healthy control group at base-
line. Children with NT1 significantly improved on total IQ score, and
on the WISC indices processing speed, and perceptual organization
1 year after treatment. At follow-­up, test scores of treated children
were largely comparable to those of the control group at baseline.
Conclusions: Children with NT1 show improvement in several cogni-
tive domains 1 year after start of treatment. Our findings stress the
need for early detection and treatment of narcolepsy in childhood.
Disclosure: This was not an industry supported study. SO received a
non-­restricted research grant on narcolepsy from UCB Pharma, not
related to the present study. GJL is part of the advisory board of UCB,
Bioprojet and Jazz Pharmaceuticals, and consultant for Jazz, and
Theronexus. GJL received a non-­restricted grant from UCB Pharma
not related. UCB also provided a restricted grant to support research
on school performance in children with NT1 (FND-­2018-­126806).
|
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UCB pharma was not involved in data analysis and management.
Conflict of interest statement: None declared.
O39 | Decrease in sleep depth is associated
with higher cerebrospinal fluid neurofilament
light levels in Alzheimer's disease patients
G. Piñol-Ripoll1; A. Targa2; I. Benitez2; F. Dakterzada3; R.
López4; F. Barbé5
1
Hospital Authority Universitari Santa Maria/IRBLleida; 2Research in
Respiratory Medicine, Hospital Universitari Arnau de Vilanova-­Santa
Maria, IRBLleida; 3Unitat Trastorns Cognitius, Clinical Neuroscience
Research, Santa Maria University Hospital, IRBLleida; 4Clinical
Laboratory, University of Lleida; 5Translational Research in Respiratory
Medicine, Hospital Universitari Arnau de Vilanova-­Santa Maria,
IRBLleida, Lleida, Spain
Objectives/Introduction: The majority of studies investigating the
association between sleep and Alzheimer's disease (AD) biomarkers
have been performed in healthy subjects. Our objective was to in-
vestigate the association between sleep and several biomarkers that
reflect distinct aspects of AD physiopathology.
Methods: The cohort included 104 individuals with mild-­moderate
AD. The subjects were submitted to one-­night polysomnography,
and cerebrospinal fluid was collected in the following morning to
measure the selected biomarkers associated with amyloid deposi-
tion, tau pathology, neurodegeneration, axonal damage, synaptic
integrity, neuroinflammation, and oxidative damage.
Results: There was a positive correlation between neurofilament
light (NF-­L) and the time spent in N1 sleep and a negative correlation
between this marker and the time spent in N3 sleep. Accordingly, we
observed that deep sleep was associated with lower levels of NF-­L ,
whereas light sleep increased the probability of having higher levels
of this marker. Furthermore, chitinase 3-­like 1 (YKL-­4 0) was nega-
tively correlated with sleep efficiency, the time spent in N2 sleep and
the time spent in N3 sleep. Conversely, there was a positive correla-
tion between N3 sleep and the oxidative protein damage markers
N-­ε-­(carboxyethyl)lysine and N-­ε-­(malondialdehyde)lysine.
Conclusions: There was substantial correlation between sleep pa-
rameters and AD biomarkers related to axonal damage and neuro-
inflammation, such as NF-­L and YKL-­4 0. A lack of deep sleep was
associated with higher levels of NF-­L . This highlights a potential role
for NF-­L as a biomarker of sleep disruption in mild-­moderate AD
patients in addition to its role in predicting neurodegeneration and
cognitive decline.
Disclosure: Nothing to disclose.
 |
22 of 356       ABSTRACTS
O R A L 6 – P S YC H I ATRY A N D
P S YC H OTH E R A PY
O40 | Racing thoughts in healthy young adults
are influenced by sleep deprivation but not by
blue enriched white light exposure
R. Glacet1; E. Reynaud1,2; L. Hugueny1,2; M. Neppel2;
S. Jung2; C. Loegel2; C. Leveratto2; C. Schröder1,2,3; H.
Comtet1,2; P. Bourgin1,2
1
CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences;
2
Sleep Disorders Center & CIRCSom (International Research Center for
3
ChronoSomnology) – Strasbourg University Hospital; Department
of Child and Adolescent Psychiatry, Strasbourg University Hospitals &
University of Strasbourg Medical School, Strasbourg, France
Objectives/Introduction: Racing thoughts refer to a subjective ac-
celeration and overproduction of thoughts which are among the
core symptoms of manic and mixed episodes in bipolar disorder, but
they can also be observed in healthy subjects. Circadian, homeo-
static and photic sleep regulatory mechanisms play a crucial role in
mood disorders, but no study has yet investigated their possible
role in influencing racing thoughts. Therefore, we conducted ‘mul-
tiple naps’ and ‘constant routine sleep deprivation’ protocols with
and without light exposure to evaluate racing thoughts according
to circadian time, homeostatic pressure level and light exposure in
healthy young adults.
Methods: 64 healthy young adults were randomized in 4 groups
(n = 16 each) and underwent a 40 h constant routine protocol.
During the 40 h, two groups alternated wake (150 min) either in dim
light (DL ; <8 lux) or blue enriched white light (BEL ; 250 lux) and nap
periods (75 min ; 0 lux). Two groups were sleep deprived (SD) and
exposed to either constant DL or alternating BEL and DL periods
(150/75 min). Racing thoughts were assessed 11 times during the
40 h and once after the recovery night by the 13-­items Racing and
Crowded Thoughts Questionnaire (RCTQ).
Results: Our results show that subscore 1 (thought overactiva-
tion) and 2 (burden of thought overactivation) of the RCTQ were
modulated by circadian time (respectively p < 0.001 and p < 0.05),
in contrast to the total score and subscore 3 (thought overexcitabil-
ity) (n = 16 per group). We have shown a consistent effect of ho-
meostatic pressure (p < 0.05) except for subscore 2. The interaction
homeostatic pressure x time was significant for the total score and
subscore 3 (p < 0.05). The effect of light didn't reach significance.
Interestingly, we highlighted that some subjects displayed unusually
high scores under SD.
Conclusions: Our results show that the homeostatic and circadian
processes play an important role, in an interactive manner, in the
modulation of racing thoughts in healthy subjects, whereas light
had no effects. Interestingly, higher scores reached by some indi-
viduals during SD raise the question of a possible sub-­symptomatic
triggering of racing thoughts by the accumulation of homeostatic
pressure in predisposed healthy subjects.
Disclosure: Nothing to disclose.
O41 | Treatment with imagery rehearsal
therapy and/or mianserin in trauma-­affected
refugees: results from a randomized controlled
trial
H. Sandahl1,2; P. Jennum3; L. Baandrup 4; E.L. Mortensen5; J.
Carlsson1,2
1
Competence Centre for Transcultural Psychiatry, Mental Health
Services in the Capital Region of Denmark, Ballerup; 2University of
Copenhagen; 3Department of Clinical Neurophysiology, Danish Center
for Sleep Medicine, Rigshospitalet – Glostrup, Copenhagen University
Hospital; 4Mental Health Center Copenhagen, Mental Health Services
in the Capital Region of Denmark; 5Department of Public Health and
Center for Healthy Aging, University of Copenhagen, Copenhagen,
Denmark
Objectives/Introduction: Sleep disturbances are frequent in refu-
gees diagnosed with PTSD. It is hypothesized that targeting sleep
disturbances in treatment may enhance PTSD treatment outcome.
However, randomized studies are lacking on the effect of treatment
focusing on sleep disturbances in trauma-­affected refugees.
The present study examined sleep enhancing treatment in trauma-­
affected refugees. We aimed to assess if add-­on treatment to treat-
ment as usual (TAU) with Imagery Rehearsal Therapy (IRT) and/or
mianserin improved sleep quality, symptoms of PTSD and depres-
sion, quality of life and level of functioning compared to TAU.
Methods: In a pragmatic randomized controlled trial 219 trauma-­
affected refugees, diagnosed with PTSD, were randomized to four
groups receiving different treatment; TAU, TAU + mianserin, TAU +
IRT, and TAU + IRT + mianserin.
The primary outcome measure was sleep quality measured on
Pittsburgh Sleep Quality Index. Secondary outcome measures were
nightmares, symptoms of PTSD and depression, quality of life and
level of functioning.
Results: Mixed model analyses were performed on the intention-­to-­
treat sample of 219 trauma-­affected refugees. Except for level of
functioning (p = 0.036), add-­on treatment with IRT did not reach a
statistical or clinically relevant difference in comparison to non-­IRT.
However, there was a consistent tendency of add-­on treatment with
IRT improving sleep quality, symptoms of PTSD and depression, and
quality of life with IRT showing a non-­significant advantage over
non-­IRT.
Compared to non-­
mianserin, add-­
on treatment with mianserin
had no significant effect on sleep quality, severity of nightmares,
symptoms of PTSD and depression, or on quality of life and level of
functioning.
ABSTRACTS
Conclusions: This randomized controlled trial is the first large scale
trial to study the effectiveness of add-­on psychotherapeutic and
psychopharmacological treatment of sleep disturbances in trauma-­
affected refugees.
Contrary to hypothesis, IRT and/or mianserin added to TAU were
not found to be superior to TAU. The low treatment response points
to further analysis of the complex factors, which may impact the
ability of trauma-­affected refugees to participate in and profit from
the various treatments offered.
Disclosure: Nothing to disclose.
O42 | Brain structural correlates of insomnia
severity in 1053 individuals with major
depressive disorder: results from the ENIGMA
MDD working group
1,2 1,2 3,4
J. Leerssen ; T.F. Blanken ; E. Pozzi ; N. Jahanshad ;
L. Aftanas6,7; O.A. Andreassen8,9; B.T. Baune10,11; C.R.K.
Ching5; U. Dannlowski11; T. Frodl12,13; B.R. Godlewska14;
I.H. Gotlib15; D. Grotegerd11; O. Gruber16; S.N. Hatton17;
I.B. Hickie17; N. Jaworska18,19; T. Kircher20; A. Krug20;
J. Lagopoulos21; M. Li22; F.P. MacMaster23,24; A.M.
McIntosh25,26; B. Mwangi27; E. Osipov6; M.J. Portella28,29;
M.D. Sacchet30; P.G. Sämann31; E. Simulionyte16; J.C.
Soares32; M. Walter33; H.C. Whalley25; D.J. Veltman34,35;
P.M. Thompson5; L. Schmaal4,36; E.J.W. Van Someren1,2,34;
on behalf of the ENIGMA Major Depressive Disorder
Working Group
1
Department of Sleep and Cognition, Netherlands Institute for
Neuroscience; 2Department of Integrative Neurophysiology, Center
for Neurogenomics and Cognitive Research (CNCR), Amsterdam
Neuroscience, VU University Amsterdam, Amsterdam, The
Netherlands; 3Department of Psychiatry, Melbourne Neuropsychiatry
Centre, The University of Melbourne & Melbourne Health, Melbourne;
4
Orygen, The National Centre of Excellence in Youth Mental Health,
Parkville, VIC, Australia; 5Imaging Genetics Center, Mark and Mary
Stevens Neuroimaging and Informatics Institute, Keck School of
Medicine of USC, University of Southern California, Marina del Rey,
CA, United States; 6Laboratory of Affective, Cognitive & Translational
Neuroscience, Scientific Research Institute of Physiology & Basic
Medicine; 7Department of Neuroscience, Novosibirsk State University,
Novosibirsk, Russian Federation; 8Division of Mental Health and
Addiction, NORMENT Centre, Oslo University Hospital; 9Institute of
10
Clinical Medicine, University of Oslo, Oslo, Norway; Department
of Psychiatry, Melbourne Medical School, University of Melbourne,
11
Melbourne, VIC, Australia; Department of Psychiatry, University of
12
Münster, Münster; Department of Psychiatry and Psychotherapy,
Otto von Guericke University Magdeburg, Magdeburg, Germany;
13
Department of Psychiatry, Trinity College Dublin, Dublin, Ireland;
14
Psychopharmacology Research Unit, Department of Psychiatry,
15
University of Oxford, Oxford, United Kingdom; Department of
|
      23 of 356
16
Psychology, Stanford University, Stanford, CA, United States; Section
for Experimental Psychopathology and Neuroimaging, Department
of General Psychiatry, Heidelberg University, Heidelberg, Germany;
17
Youth Mental Health Team, Brain and Mind Centre, University of
18
Sydney, Sydney, NSW, Australia; Institute of Mental Health Research,
19
affiliated with the University of Ottawa; Cellular & Molecular
20
Medicine, University of Ottawa, Ottawa, ON, Canada; Department
of Psychiatry and Psychotherapy, Philipps-­University Marburg,
21
Marburg, Germany; Sunshine Coast Mind and Neuroscience
Thompson Institute, Queensland, Australia, Birtinya, QLD, Australia;
22
Max Planck Institute for Biological Cybernetics, Tübingen, Germany;
23 24
Psychiatry and Paediatrics, University of Calgary; Strategic
Clinical Network for Addictions and Mental Health, Calgary, AB,
25 26
Canada; Division of Psychiatry, University of Edinburgh; Centre
for Cognitive Ageing and Cognitive Epidemiology, University of
Edinburgh, Edinburgh, United Kingdom; 27
Department of Psychiatry,
University of Texas Health Science Center at Houston, Houston, TX,
28
United States; Department of Psychiatry, Institute of Biomedical
5 29 30
Research Sant Pau; CIBERSAM, Barcelona, Spain; Department
of Psychiatry and Behavioral Sciences, Stanford University, Stanford,
CA, United States; 31
Max Planck Institute of Psychiatry, Munich,
Germany; 32
Department of Psychiatry and Behavioral Sciences, UT
Center of Excellence on Mood Disorders, University of Texas Health
Science Center at Houston, Houston, TX, United States; 33
Department
of Psychiatry and Psychotherapy, University of Tübingen, Tübingen,
Germany; 34
Department of Psychiatry, Amsterdam UMC, Amsterdam
Neuroscience, VU University; 35
Amsterdam Neuroscience, VU
University Medical Center, Amsterdam, The Netherlands; 36
Centre for
Youth Mental Health, The University of Melbourne, Melbourne, VIC,
Australia
Objectives/Introduction: Insomnia is an important symptom of
major depressive disorder (MDD). Neural correlates of insomnia in
MDD have remained elusive, while their understanding could pro-
vide clues for better treatment. In the current study, we aimed to
assess brain structural correlates of insomnia severity.
Methods: Cortical thickness, surface area and subcortical volumes
were assessed from T1-­weighted brain magnetic resonance imaging
(MRI) scans of 1,053 MDD patients (age range 13–79 years) from 15
cohorts within the ENIGMA MDD Working Group. Insomnia sever-
ity was measured by summing the insomnia items of the Hamilton
Depression Rating Scale (HDRS). Linear mixed model analyses were
used to assess associations of insomnia severity with overall and re-
gional measures of cortical surface area, cortical thickness and sub-
cortical volumes. All models were adjusted for age, sex, scanner site,
and insomnia-­independent depression severity (total HDRS minus
insomnia items). Disease specificity was evaluated in two independ-
ent samples comprising 2108 healthy controls, and in 260 clinical
controls with bipolar disorder.
Results: MDD patients with more severe insomnia had a smaller total
cortical surface area (p = 0.044), mostly driven by the left inferior
frontal gyrus pars triangularis (p = 0.018), right superior parietal cor-
tex (p = 0.026), right insula (p = 0.031), left frontal pole (p = 0.031),
 |
24 of 356       ABSTRACTS
right medial orbitofrontal cortex (p = 0.031), and right supramarginal
gyrus (p = 0.031). Associations were specific for insomnia severity,
and were not found for overall depression severity represented by
the mixture of symptoms assessed by the HDRS. Associations were
also specific to insomnia in MDD; differential association profiles
were revealed in healthy controls and clinical controls.
Conclusions: Our study showed that insomnia is more severe in pa-
tients with MDD who have a smaller cortical surface area, in par-
ticular in several frontoparietal cortical areas. The better specificity
of these associations with insomnia severity than with overall de-
pression severity, highlights the possibility that neural correlates of
a psychiatric disorder may remain hidden in heterogeneity if they are
not generic to overall severity. Neurobiological underpinnings may
better be revealed by distinct within-­disorder and symptom-­specific
associations.
Disclosure: Nothing to disclose.
O43 | Objectively estimated sleep
characteristics are associated with grief over
time: the Rotterdam study
M. de Feijter1; M.-F. O'Connor2; B.J. Arizmendi2,3; M.A.
Ikram1; A.I. Luik1,4
1
Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands;
2
Psychology, University of Arizona, Tucson; 3Psychology, Phoenix VA
4 2
Health Care System, Phoenix, AZ, United States; Child and Adolescent
Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
Objectives/Introduction: Poor sleep is associated with psychologi-
cal difficulties, including grief. Most people experience grief after
bereavement and about 10% develop prolonged grief, causing sig-
nificant impairment in daily life. Subjective complaints of poor sleep
are common in those with grief; however, the role of objectively es-
timated sleep in developing prolonged grief remains largely unclear.
Methods: In 1,776 participants (mean age: 62 ± 9 years, 55% women)
from the population-­based Rotterdam Study, we assessed the as-
sociation of objective and self-­rated sleep with grief. Of 1,431 par-
ticipants (81%) we had repeated measures of grief over a median
follow-­up of 6 years (IQR:5.6–6.3). At baseline, sleep was estimated
using actigraphy (mean duration 6 ± 0.8 days) and the Pittsburg Sleep
Quality Index (PSQI). Grief was assessed at baseline and follow-
­up by asking about any bereavements and using the Inventory for
Complicated Grief (ICG) (cut-­off ≥22). Participants were classified
as non-­grieving (n = 1,521), acute grievers (bereavement <6 months,
any ICG score, n = 44), non-­
disordered grievers (bereavement
≥6 months, ICG < 22, n = 158), and prolonged grievers (bereavement
≥6 months, ICG ≥22, n = 53). We used multi-­nominal analyses and
linear regression models to estimate the association of sleep with
grief category and number of grief symptoms.
Results: Over time, persons with a 1-­hour decrease in total sleep
time at baseline were more likely to experience prolonged grief
disorder (OR = 0.56, p = 0.035, vs non-­disordered grief), even after
controlling for depressive symptoms (OR = 0.58, p = 0.043). In
those indicating grief at baseline (n = 255), cross-­sectional analyses
showed that a short sleep duration (ß = −1.64, p = 0.021), low sleep
efficiency (ß = −0.18, p = 0.009), long sleep onset latency (ß = 0.07,
p = 0.031), long wake after sleep onset (ß = 0.07, p = 0.003), and high
self-­rated sleep quality score (ß = 0.56, p < 0.001) were associated
with more grief symptoms. For sleep efficiency (ß = −0.14, p = 0.038)
and wake after sleep onset (ß = 0.06, p = 0.005), the results remained
significant after correcting for depressive symptoms. Longitudinally,
sleep was not associated with the number of grief symptoms.
Conclusions: This study suggests that sleep is cross-­
sectionally
and longitudinally associated with grief. Poor sleep characteristics
were associated with the number of concurrent grief symptoms.
Furthermore, short sleep duration increased the odds of experienc-
ing prolonged grief disorder 6 years later.
Disclosure: Nothing to disclose.
O44 | Antenatal insomnia and increased
postnatal dehydroepiandrosterone predict
postnatal depression
T. Mikoteit1,2; N. von Felten1; I. Hoesli3; S. Tschudin3; A.
Eckert4; M. Hatzinger1,2; S. Brand4,5,6
1
Psychiatric Services Solothurn|KPPP, Solothurner Spitäler, Solothurn;
Faculty of Medicine, University of Basel; 3Clinic of Obstetrics
and Gynecology, University Hospital Basel; 4Psychiatric Clinics;
5
Department of Sport, Exercise and Health, University of Basel, Basel,
Switzerland; 6Department of Psychiatry, Sleep Disorders Research
Center, Kermanshah University of Medical Sciences, Kermanshah,
Islamic Republic of Iran
Objectives/Introduction: Insomnia could be both, a risk factor and a
key symptom of major depression. Moreover, in late pregnancy, in-
somnia is a common complaint and may predict evolvement of post-
natal depression (PND). Further, as pregnancy is characterized by
substantial changes of neurosteroid hormone levels, unfavourable
neurosteroid alterations may also predict the risk of PND [1]. It is
unclear, if and if so, to what extent the combination of dimensions of
poor sleep and neurosteroid levels during pregnancy might predict
the risk of PND. Given this, the aims of this study were to examine 1)
if antenatal insomnia is a predictor of PND, and 2) if such an associa-
tion is related to perinatal neurosteroid levels.
Methods: Thirty-­
one pregnant women (age: 33.3 ± 4.4 years,
49% primipara) were enrolled in this prospective and longitudinal
study. Participants completed self-­rating questionnaires on depres-
sion (Edinburgh Postnatal Depression Scale; EPDS); and insomnia
(Insomnia Severity Index (ISI)) at the following time points: 32nd
week of gestation (32nd WG); 2 days postpartum; 12 weeks post-
partum (12w pp). In parallel, experts rated participants’ depression
severity with the Hamilton Depression rating Scale (HAMD). To
ABSTRACTS
assess the cumulative production of cortisol, cortisone, dehydroe-
piandrosteron (DHEA) and progesterone, hair steroid hormone
analyses reflecting hormone deposits of the past 3 months (i.e. 3rd
trimester and 3 months p.p., resp.) were performed.
Results: Higher insomnia scores 32nd WG correlated with both
higher EPDS scores 12w pp (τ = 0.471, p = 0.003) and higher HAMD
scores 12w pp (τ = 0.332, p = 0.030). Compared to normal sleepers
(ISI 32nd WG scores <15), poor sleepers (ISI 32nd WG scores ≥15)
had higher EPDS scores prospectively (F(1,20) = 10.41, p = 0.004,
2
partial η  = 0.342). Descriptively, increased insomnia scores 32nd
WG correlated with increased postnatal DHEA levels (τ = 0.305,
p = 0.090). Increased postnatal DHEA levels were significantly asso-
ciated with higher experts’ rated HAMD scores (τ = 0.391, p = 0.033)
and EPDS scores (τ = 0.370, p = 0.042) at 12 weeks pp.
Conclusions: The pattern of results suggests that 1) antenatal insom-
nia increased the risk of PND, and that 2) the association between
poor sleep and PPD is related to increased DHEA levels.
Disclosure: Nothing to disclose.
O45 | Become your own SLEEPexpert: design,
implementation and first evaluation of a
pragmatic behavioral treatment program for
insomnia in patients with acute psychiatric
disorders
C.L. Schneider1; E. Hertenstein1; K. Fehér1; J.G. Maier1; A.
Cantisani1; F. Moggi1; T. Berger2; C. Nissen1
1 IL, United States; 4Institute of Biomedical Engineering, University
University Psychiatric Services, University Hospital of Psychiatry and
Psychotherapy; 2Clinical Psychology and Psychotherapy, University of
Bern, Berne, Switzerland
Objectives/Introduction: Mental disorders are among the leading
causes of reduced quality of life due to illness. The majority of pa-
tients with mental disorders suffer from insomnia, associated with
adverse health outcomes. Cognitive behavioral therapy for insomnia
(CBT-­I) is identified as first-­line treatment but is too complex for se-
verely ill patients and not systematically implemented in psychiatric
care. This project aims to empower patients with severe acute mental
disorders to take care of their own sleep health based on a pragmatic
behavioural treatment program (‘Become your own SLEEPexpert’) that
empowers patients with severe acute mental disorders to take care
of their own sleep health.
Methods: CBT-­I was adapted based on implementation research
involving 24 inpatients with psychiatric disorders across diagnos-
tic entities and comorbid insomnia and 30 health care providers at
the University Hospital of Psychiatry and Psychotherapy, Berne.
SLEEPexpert was implemented and evaluated in 15 patients based
on interviews and questionnaires before participation and prior to
discharge (day 17.9 ± 6.7).
|
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Results: Implementation research resulted in the SLEEPexpert inter-
vention, centering on bedtime restriction and circadian adaptation in
three phases; therapist-­guided treatment initiation, self-­management
with nursing support, and self-­
management. Evaluative pre-­
post
assessments in 15 patients demonstrated feasibility. Time in bed
decreased by 60 minutes (520 vs. 460 min, p = 0.031) and sleep ef-
ficiency increased (65.3 vs. 81.9%, p = 0.011). Patients improved on
the Insomnia Severity Index (18.3 ± 4.6 vs.11.4 ± 4.4, p < 0.001) and
Pittsburgh Sleep Quality Index (12.9 ± 3.8 vs.10.3 ± 3.3, p = 0.031).
Conclusions: We propose a new pragmatic behavioural treatment
program (SLEEPexpert) customised to the needs of inpatients in
acute psychiatric care. Data demonstrate feasibility and preliminary
evidence for efficacy. Given the substantial burden of mental disor-
ders and comorbid insomnia, further developments are of high pub-
lic health relevance.
Disclosure: Nothing to disclose.
O46 | The temporal dynamics of sleep
disturbance and psychopathology in psychosis: a
digital phenotyping study
N. Meyer1; D.W. Joyce2; C. Karr3; M. de Vos4,5;
D. Derk-Jan6,7; N.C. Jacobson8; J.H. Maccabe1
1
Department of Psychosis Studies, Institute of Psychiatry, Psychology
and Neuroscience, London; 2Oxford Health NIHR Biomedical Research
Centre, Warneford Hospital, Department of Psychiatry, University of
Oxford, Oxford, United Kingdom; 3Audacious Technologies, Chicago,
of Oxford, Oxford, United Kingdom; 5Department of Engineering,
Department of Development and Regeneration, KU Leuven, Leuven,
Belgium; 6Surrey Sleep Research Centre, Faculty of Health and Medical
Sciences, University of Surrey; 7UK Dementia Research Institute
– Care Research & Technology, London, United Kingdom; 8Center
for Technology and Behavioral Health, Geisel School of Medicine,
Dartmouth College, Lebanon, NH, United States
Objectives/Introduction: Sleep disruption is a common precursor to
deterioration and relapse in people living with psychotic disorders.
Understanding the temporal relationship between sleep and psy-
chopathology is important for identifying and developing interven-
tions which target key variables that contribute to relapse.
Methods: We used a purpose-­built digital platform to sample self-­
reported and objective sleep variables from thirty-­six people with
schizophrenia, over 1 year. Once-­daily self-­reported measures of
sleep (sleep duration and sleep quality) and fluctuations in psycho-
pathology (positive and negative affect, cognition, and psychotic
symptoms) were captured using a smartphone diary. Objective sleep
variables were derived from continuous data from smartphone sen-
sors and a wearable device. The temporal relationship between
sleep and psychopathology variables were examined across multiple
 |
26 of 356       ABSTRACTS
individuals using the Differential Time-­Varying Effect (DTVEM) hy-
brid exploratory-­confirmatory model.
Results: Poorer subjective sleep quality and shorter sleep duration
maximally predicted deterioration in psychosis symptoms over the
subsequent 1–8 and 1–12 days, respectively. Similarly, shorter ob-
jective sleep duration anticipated worsened psychosis symptoms by
1–4 days. These relationships were mediated by negative affect and
cognitive symptoms. Psychopathology variables also predicted sub-
jective sleep quality, but not subjective or objective sleep duration,
however the effect sizes were smaller and of shorter lag duration.
Conclusions: Reduced sleep duration and poorer sleep quality
precede exacerbation of psychotic symptoms by approximately
1–2 weeks, and negative affect and cognitive symptoms mediate this
relationship. Sleep disturbance may play a causal role in symptom
exacerbation and relapse, and represents an important and tracta-
ble target for intervention. Sleep disturbance warrants greater at-
tention as an early warning sign of deterioration, and low-­burden,
user-­friendly digital tools may play a role in their early detection.
Disclosure: Nothing to disclose.
O R A L 7 – N EU RO B I O LO G Y &
OS C I LL ATI O N S
O47 | In vitro generation of sleep spindles and
slow waves using thalamo-­cortical co-­cultures
M. Bandarabadi; M. Tafti
Department of Biomedical Sciences, University of Lausanne, Lausanne,
Switzerland
Objectives/Introduction: Sleep has been conceptualized
‘activity-­dependent’, hence a response to prior waking experience,
and proposed to be ‘the price the brain pays for plasticity during
wakefulness’. We here show that at the level of neuronal networks,
particularly those arising from isolated embryonic thalamo-­cortical
or cortical neurons maintained in culture, it represents a default
mode of functioning.
Methods: We recorded both local field potential (LFP) and single-­
unit activity from primary co-­cultures of thalamo-­cortical neurons
using a high-­density microelectrode array with 24,000 channels. We
analyzed LFPs, performed spike sorting, and assessed sleep oscilla-
tory patterns.
Results: We found that cell assemblies of in vitro thalamo-­cortical
co-­cultures and cortical cultures mimic oscillatory patterns of sleep
spindles and slow waves, respectively, at both the LFP and unit lev-
els similar to non-­rapid eye movement sleep (n = 9 thalamo-­cortical
co-­cultures, n = 8 cortical cultures). Furthermore, sleep spindles in
co-­culture showed strong coupling to the slow waves as in vivo, while
slow waves travelled in culture as in intact cortex. Additionally, stim-
ulation of cortical cultures and thalamo-­cortical co-­cultures using
wake-­promoting neuromodulators induced desynchronized wake-­
like states in vitro.
Conclusions: Our results demonstrate that sleep is the default state
of cortical and thalamo-­cortical networks, and highlight the poten-
tial applications of developing in vitro sleep models to answer open
questions in the field.
Disclosure: Nothing to disclose.
O48 | Role of the Locus Coeruleus in the
continuity-­fragility dynamics of NREM sleep
A. Osorio-Forero; R. Cardis; L.M. Fernandez; C. Devenoges;
J.-P. Hornung; A. Luthi
DNF, University of Lausanne, Lausanne University, Lausanne,
Switzerland
Objectives/Introduction: Non-­rapid-­eye-­movement (NREM) sleep
in mouse fluctuates between fragility and continuity periods on the
~50 s time scale (0.02 Hz) characterized by different sensory arous-
ability. Hallmarks of this fluctuation are present in the variations of
EEG power in the sigma band (10–15 Hz), of sleep spindle density, of
heart rate and pupil diameter. The noradrenergic Locus Coeruleus
(LC) is a strong candidate to underlie this 0.02 Hz-­fluctuation due to
its role in sensory arousability and bodily homeostasis. Here, we ask
whether the real-­time dynamics of LC activity is involved in behavio-
rally relevant variations of arousability during NREM sleep.
Methods: First, we injected alpha-­and beta-­adrenoceptor blockers
in somatosensory thalamus, a primary origin for sigma activity in
mouse, to study the role of noradrenergic signaling in sigma activity
and sleep spindle dynamics in the primary somatosensory cortex S1.
Second, we optogenetically stimulated or inhibited LC activity dur-
as ing NREM sleep in mice expressing excitatory or inhibitory opsins
in dopamine-­b-­hydroxylase-­expressing LC neurons. Third, we op-
togenetically stimulated LC terminals in either the somatosensory
thalamus or cortex to assess area-­specific roles of LC axonal activity.
Finally, we explored the timing of LC activity through optogenetic
interference limited to either continuity or fragility periods using
closed-­loop stimulation techniques.
Results: Pharmacological blockage of adrenoceptors reversibly abol-
ished the 0.02 Hz-­fluctuation and increased sleep spindle density
(n = 5; both p < 0.01). LC optogenetic stimulation decreased sigma
activity and spindles compared to sham stimulation (n = 8; both
p < 0.01); this manipulation increased the amount of NREM sleep
(p < 0.05) and decreased REM sleep (p = 0.05). The opposite trends
were found after optogenetic inhibition of these neurons (n = 3).
Activation of LC terminals in the thalamus (n = 4) but not in the cor-
tex (n = 3) partially reproduced the effects of somatic stimulation.
Finally, closed-­loop stimulation of LC during continuity periods sup-
pressed the 0.02 Hz-­fluctuation whereas it entrained it during fragil-
ity period stimulation.
ABSTRACTS
Conclusions: This study addresses the dynamics of LC activity that
are relevant for behavioral arousability during NREM sleep. The re-
sults suggest an implication of periodic noradrenaline release on the
0.02 Hz-­time scale in the fragility and continuity periods of NREM
sleep.
Disclosure: Nothing to disclose.
O49 | Sharp wave-­ripples in human amygdala
and their coordination with hippocampus during
NREM sleep
R. Cox1,2; T. Rüber1,3,4; B. Staresina5; J. Fell1
1
Department of Epileptology, University of Bonn, Bonn, Germany;
2
Department of Sleep & Cognition, Netherlands Institute for
Neuroscience, Amsterdam, The Netherlands; 3Department of
4
Neurology, Epilepsy Center Frankfurt Rhine-­Main; Center for
Personalized Translational Epilepsy Research (CePTER), Goethe
University Frankfurt, Frankfurt am Main, Germany; 5School of
Psychology, University of Birmingham, Birmingham, United Kingdom
Objectives/Introduction: Cooperative interactions between the
amygdala (AMY) and hippocampus (HPC) are widely regarded as
critical for overnight emotional processing of waking experiences,
but direct support from the human brain for such a dialog is absent.
Ripples, ~80 Hz oscillations found in human HPC and various neo-
cortical regions, are associated with neuronal replay and could be of
potential interest for such AMY-­HPC interactions.
Methods: We recorded bipolar intracranial EEG from AMY and HPC
in four pre-­surgical epilepsy patients (two male, two female) dur-
ing non-­rapid eye movement (NREM) sleep. We performed visual
examinations, automated ripple detection, ripple co-­
occurrence
analyses, and various ripple-­locked time-­frequency approaches to
characterize local and interregional AMY-­HPC ripple-­related dynam-
ics. Surrogate approaches were used for statistical evaluation.
Results: We identified human NREM ripples in both AMY and HPC.
Like HPC ripples, AMY ripples were strongly associated with ~3 Hz
sharp waves, linked to ~13 Hz sleep spindles, and tended to co-­
occur with their HPC counterparts. Moreover, sharp waves and rip-
ples were temporally linked across the two brain structures, with
AMY ripples occurring during HPC sharp waves and vice versa.
Additionally, evidence of interregional sharp wave and spindle syn-
chronization were found. These findings were statistically significant
relative to surrogate distributions.
Conclusions: Ripple-­related AMY-­HPC interactions offer a potential
physiological substrate for the NREM-­sleep-­dependent consolida-
tion and regulation of emotional experiences.
Disclosure: Nothing to disclose.
|
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O50 | Sleep slow waves generation and medial
prefrontal microstructure in healthy older
individuals
M. Van Egroo1,2; D. Chylinski2; J. Narbutas2,3; N.
Vandeleene2; M. Grignard2; M. Deantoni2; P. Cardone2; V.
Muto2,3; C. Schmidt2,3; E. Koshmanova2; C. Mouraux2; C.
Berthomier4; M. Brandewinder4; F. Collette2,3; C. Bastin2,3;
E. Salmon2,3,5; P. Maquet2,3,5; E. Balteau2; C. Phillips2,6; G.
Vandewalle2
1
Faculty of Health, Medicine and Life Sciences, School for Mental
Health and Neuroscience, Alzheimer Centre Limburg, Maastricht
University, Maastricht, The Netherlands; 2GIGA-­Cyclotron Research
Centre-­In Vivo Imaging; 3Psychology and Cognitive Neuroscience
Research Unit, University of Liège, Liège, Belgium; 4Physip SA, Paris,
France; 5Department of Neurology, University Hospital of Liège;
6
GIGA-­In Silico Medicine, University of Liège, Liège, Belgium
Objectives/Introduction: Aging is associated with alterations in
sleep-­wake regulation that have been associated with changes in
brain structural integrity. In particular, the ability to generate slow
oscillations during non-­rapid eye movement (NREM) sleep decreases
as early as in the 5th decade of life, predominantly over frontal re-
gions. While previous investigations have identified macrostructural
brain correlates of the age-­related decrement in sleep slow waves
generation, their relationships with brain tissue microstructure re-
main poorly understood.
Methods: We recorded sleep under electroencephalography in 99
healthy older individuals (mean age = 59.6 ± 5.2 years; 66 women),
and we quantified slow waves generation using the overnight cu-
mulated power density in the delta band (0.5–4 Hz) during NREM
sleep over the frontal Fz derivation. All participants also underwent
3T magnetic resonance imaging (MRI) scans to investigate tissue
myelin content based on quantitative magnetization transfer (MT)
saturation mapping, as well as diffusion-­based metrics derived from
neurite orientation dispersion and density imaging (NODDI) model.
A region of interest covering bilateral medial prefrontal cortices was
used to extract regional grey matter values.
Results: We first observed that MT signal in the medial prefrontal
cortex was positively associated with higher neurite orientation dis-
persion (r = 0.30, p  = 0.003) and density (r = 0.22, p  = 0.03), sup-
posedly reflecting preserved microstructural integrity. Crucially,
overnight NREM sleep slow waves generation was significantly
related to higher prefrontal MT signal (r  = 0.22, p  = 0.03), but not
to NODDI metrics (dispersion: r = 0.02, p = 0.85; density: r = 0.09,
p = 0.36). Generalized linear mixed models adjusted for demograph-
ics (age, sex, education) and total sleep time confirmed these rela-
tionships, although as a statistical trend for MT signal (F1,93 = 3.64,
p = 0.06).
Conclusions: Our findings suggest a positive association between
tissue myelin content within medial prefrontal grey matter and
generation of slow waves during NREM sleep in aging. Preserved
 |
28 of 356       ABSTRACTS
prefrontal myelination may facilitate neuronal synchronization
through enhanced cortico-­cortical connections, resulting in higher
power density in the slower frequency band. Given the existing link
between sleep characteristics and age-­
related cognitive decline,
these results may have implications for successful cognitive aging.
Disclosure: The authors have no conflict of interest to disclose.
Sources of funding: FNRS, ULiège, ARC17/21-­
09, FEDER, WBI,
Clerdent Foundation, Leon Frédéricq Foundation.
O51 | Coordination of brain and heart
oscillations during NREM sleep
C. Mikutta1,2; M. Wenke1; K. Spiegelhalder3; E. Hertenstein1;
J. Maier1; A. Altorfer1; D. Riemann3; B. Feige3; C. Nissen1
1 Objectives/Introduction: REM sleep occupies around 20 % of night-
University Hospital of Psychiatry, University of Bern, Bern;
2 time sleep in healthy human adults and is associated with a variety
Privatklinik Meiringen, Meiringen, Switzerland; 3Department of
Psychiatry and Psychotherapy, Medical Center, University of Freiburg,
Faculty of Medicine, Freiburg, Germany
Objectives/Introduction: Oscillatory activities of the brain and the
heart show a strong variation across the major behavioral states,
i.e. wakefulness and sleep. Separate lines of research indicate that
non rapid eye movement (NREM) sleep is characterized by electro-
encephalographic (EEG) slow oscillations (SO), sleep spindles, and
phase-­amplitude coupling of these oscillations, as well as an increase
in high-­
frequency heart rate variability (HF-­
HRV), reflecting en-
hanced parasympathetic activity. The current work aimed to further
investigate a potential association between brain and heart oscilla-
tions during NREM sleep.
Methods: Data were derived from one sleep laboratory night with
polysomnographic monitoring in 45 healthy participants (23 male, 22
female; mean age 36 years). The association between the strength
(modulation index, MI) and the phase direction of the slow oscillation
and spindle coupling with HF-­HRV during NREM sleep was investi-
gated using linear modelling and circular statistics.
Results: First, we found a strong interaction between SO and sleep
spindles during NREM sleep resulting in a significant MI values for all
participants. Second, we found that spindles peaks are likely to occur
on the upstate of the SO (phase direction). Third, linear model analy-
ses using NREM sleep of the entire night showed a highly significant
relationship between the strength of the slow oscillation and spin-
dle coupling (MI) and HF-­HRV (F = 20.1, p < 0.0001) and a tenta-
tive circular linear correlation between HF-­HRV and phase direction
(r = 0.35, p = 0.056). Fourth, post-­hoc analyses of NREM sleep in the
first three sleep cycles verified a significant relationship between
the MI and HF-­HRV in all three cycles (F = 16.1, p < 0.0001).
Conclusions: We demonstrate, to our knowledge for the first time, a
coordination between the central slow oscillation and sleep spindle
coupling and HF-­HRV during NREM sleep. Continuing analyses of
the fine-­graded coordination of brain and heart oscillations might
improve our understanding of the clinical links between sleep and
cardiovascular health.
Disclosure: Nothing to disclose.
O52 | Interoception in REM sleep: cortical
responses to heartbeats differ across phasic and
tonic REM periods
P. Simor1; T. Bogdány1; R. Bódizs2; P. Perakakis3
1
Eötvös University, Institute of Psychology and Education;
2
Semmelweis University, Budapest, Hungary; 3Universidad de
Granada, Granada, Spain
of functions from basic physiological mechanisms, to complex cogni-
tive phenomena. REM sleep features two distinct microstates: pha-
sic and tonic. Previous studies indicate that sensory processing is
largely diminished during phasic REM, whereas environmental alert-
ness is partially reinstated when the brain switches into tonic REM.
Although a rich source of information for the sleeping brain is arising
from the body through a stream of afferent signals whose neural
processing is known under the term interoception, no previous stud-
ies have explicitly investigated the processing of internal signals dur-
ing phasic and tonic REM microstates.
Methods: We investigated interoceptive processing as quantified
by the heartbeat evoked potential (HEP) during REM microstates
and resting wakefulness. We contrasted the HEPs of these differ-
ent vigilance states using two separate databases that included the
nighttime polysomnographic recordings of healthy young individuals
(N = 20 and N = 19).
Results: Differences in HEP amplitudes between tonic and phasic
REM were observed in both studies (cluster level p = 0.045 in Study
1, and p = 0.006 in Study 2) over a late time window (~550–650 ms),
peaking at frontocentral derivations. Furthermore, the late HEP
component differentiating the two REM microstates was statisti-
cally different between wakefulness and phasic REM sleep (Study
1: p = 0.09 and Study 2: p = 0.012), but not across wakefulness and
tonic REM sleep, showing a similar patterns of differences in both
studies.
Conclusions: Our results indicate that interoception with respect
to cardiac signals is not uniform across REM microstates, and sug-
gest that interoceptive processing is partially reinstated during tonic
REM periods. We may speculate that increased cortical processing
of cardiac activity may reinstate bodily representations that could
also facilitate external processing and prepare the organism for
motor control following awakening. On the other hand, the brain ap-
pears to be less sensitive to cardiac afferent signals during phasic
REM periods, when internally generated sensorimotor processing is
temporarily liberated from the constraints of external stimuli, which
ABSTRACTS |
      29 of 356

presumably contributes to the peculiar sensorimotor experiences of the time bins*genotype interaction was driven by lower delta power
dreaming. for PER34/5 (p < 0.05) relative to PER34/4 in the first part of the night.
Disclosure: Nothing to disclose. Conclusions: PER34/5 individuals showed lower delta power at the
beginning of the night across a variety of sleep contexts, including
entrained night-­time sleep, but also under conditions of dispropor-
O53 | Impact of the PER3 VNTR polymorphism tionally high and low sleep pressure. Unexpectedly, the current set-
ting did not reveal differences between homozygous individuals.
on delta power across different sleep contexts
Future analysis will investigate topographical aspects, dissociation
between time and power-­specific characteristics of slow wave gen-
V. Muto1,2; G. Frasso3; M. Jaspar1,2; C. Meyer1,2; S.
eration as well as which multivariate combination of sleep electro-
Chellappa1; J. Ly1,4; G. Gaggioni1; C. Berthomier5; M.
physiological signatures best segregates PER3 categories.
Brandewinder5; C. Phillips1,6; F. Collette1,2,7; S. Archer8;
Disclosure: The authors have no conflict of interest to disclose.
D.-J. Dijk8; P. Maquet1,2,4; G. Vandewalle1; C. Schmidt1,7; G.
Sources of funding: University of Liège, ARC of Wallonia-­Brussel
Hammad1
1 federation, Belgian Fund for Scientific Research (FNRS), European
GIGA-­Institute, Cyclotron Research Centre, In Vivo Imaging, Sleep
2 Research Council (ERC-­Starting Grant).
and Chronobiology Lab, University of Liège, Liège; WELBIO, Walloon
3
Excellence in Lifesciences & BIOtechnology, Bruxelles; Faculty of
Social Sciences, Quantitative Methods for Social Sciences, University of
Liège; 4Department of Neurology, University Hospital of Liège, Liège,
O R A L 8 – PA E D I ATR I C S
5 6
Belgium; PHYSIP, Paris, France; GIGA-­In Silico Medicine, University
of Liège; 7Psychology and Neurosciences of Cognition (PsyNCog),
University of Liège, Liège, Belgium; 8Surrey Sleep Research Centre, O54 | Daytime continuous polysomnography in
University of Surrey, Guildford, United Kingdom the diagnosis of pediatric narcolepsy type 1

F. Pizza1,2; S. Vandi1,2; M. Filardi1; C. Franceschini3; L.

Objectives/Introduction: A human variable number tandem repeat
(VNTR) polymorphism in the clock gene PERIOD3 (PER3) has been
associated with sleep homeostasis. Individuals homozygous for the
longer allele (PER35/5) showed higher delta power at the beginning
of nighttime sleep compared to shorter allele homozygous (PER34/4)
under baseline condition and following sleep loss. Here, we assessed
the impact of PER3 on sleep delta power across different experimen-
tal conditions including sleep loss and sleep satiation.
Methods: Participants (N = 358; mean age 22.1 ± 2.7; all male) un-
derwent an in-­lab study consisting of 4 consecutive conditions: 1)
BASELINE night adjusted to habitual sleep-­wake schedule, 2) 12-­hr
EXTENSION night, 3) 8-­hr SATIATED night preceding a 40-­hr sleep
deprivation, 4) 12-­
hr RECOVERY night. Participants were retro-
spectively genotyped for the PER3 polymorphism (PER34/4 n = 155;
PER35/5 n = 39; PER34/5 n = 164). NREM spectral power in the delta
band (0.5–4 Hz) was extracted from a bipolar channel (Cz-­Pz) after
artifact rejection. Delta power was expressed as mean power per
NREM epoch over 2-­hr time bins. Statistical analyses consisted in
a linear mixed-­effect model with NREM delta power as dependent
variable, subjects as random intercept, sleep conditions as nested
factor, time bins as random slope, and PER3 as a categorical factor.
Results: We observed a main effect of genotype (F(2,355) = 3.123,
p < 0.05), condition (F(3,6680) = 988.331, p < 0.001), and time
bins (F(1,6680) = 9563.808, p < 0.001), as well as genotype*time
bins (F(2,6680) = 5.501, p < 0.01) and condition*time bins
(F(3,6680) = 76.784, p < 0.001) interactions. The genotype*condition
interaction and the triple genotype*time bins*condition interaction
were not significant (all ps > 0.05). Post-­hoc analyses showed that
Vignatelli2; E. Antelmi1,4; F. Ingravallo5; M. Moresco2; E.
Mignot6; O. Bruni7; L. Nobili8,9; P. Veggiotti10; R. Ferri11; G.
Plazzi1,2
1
Department of Biomedical and Neuromotor Sciences (DIBINEM),
University of Bologna; 2IRCCS Istituto delle Scienze Neurologiche di
Bologna, Bologna; 3Department of Medicine and Surgery, University
of Parma, Parma; 4Department of Neurosciences, Biomedicine and
Movement Sciences, University of Verona, Verona; 5Department of
Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna,
Italy; 6Department of Psychiatry and Behavioral Sciences, Stanford
University Center for Sleep Sciences, Stanford University School of
Medicine, Palo Alto, CA, United States; 7Department of Developmental
and Social Psychology, Sapienza University, Rome; 8Unit of Child
Neuropsychiatry, IRCCS Istituto Giannina Gaslini; 9Dipartimento
di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze
10
Materno-­Infantili, DINOGMI, University of Genoa, Genoa; Pediatric
11
Neurology Unit, V. Buzzi Hospital, University of Milan, Milan; Oasi
Research Institute – IRCCS, Troina, Italy
Objectives/Introduction: Type 1 Narcolepsy (NT1) is still largely
misdiagnosed or underdiagnosed in children also for difficulties to
obtain a reliable diagnostic evaluation. NT1 fingerprints are sleep
onset REM periods (SOREMPs) documented during nocturnal poly-
somnography (nPSG) followed by the multiple sleep latency test
(MSLT), cataplexy, and cerebrospinal hypocretin-­1 (CSF hcrt-­1) defi-
ciency. Obtaining reliable MSLT results is not always possible, since it
requires children's active collaboration and a dedicated setting. We
aimed at validating daytime continuous polysomnography (D-­PSG),
 |
30 of 356       ABSTRACTS
an extension of the ambulatory EEG monitoring largely used in pedi-
atric neurology, for NT1 diagnosis in children.
Methods: Two hundred consecutive patients aged <18 years were
included (112 with NT1, 25 with other central disorders of hyper-
somnolence, and 63 with subjective sleepiness complaint). D-­PSG
findings from a 24-­
hours continuous PSG recording (number of
naps (n-­NAPs), total sleep time (D-­TST), number of SOREMPs (D-­
SOREMPs)) were tested as single parameters and in combination
against NT1 diagnosis by applying ROC curves analysis to extract
cut-­offs in a randomly selected group of 133 patients (group 1).
Diagnostic testing performances indicators were calculated for vali-
dation in the second group of 67 patients and in the whole dataset.
Results: The presence of at least 1 D-­SOREMPs (area of 0.913, S.E.
0.026, p = 6 E -­16), at least 2 n-­NAPs (area of 0.813, S.E. 0.038, p = 9
E-­10), and more than 60 minutes of D-­TST (area of 0.695, S.E. 0.05,
p = 0.0001) best identified NT1 patients as single parameters in group
1. Diagnostic odd ratios showed the best diagnostic performances
for the combination of D-­TST >60 min + at least 1 D-­SOREMP (O.R.
of 27.86 and of 49.05 in group 2 and in the whole dataset respec-
tively), followed by the presence of at least 1 D-­SOREMP (O.R. of
26.10 and of 44.33 in group 2 and in the whole dataset respectively).
Conclusions: D-­PSG recording is an ecological, easy to perform,
cost-­effective, and reliable tool for identifying NT1 children also
outside of the sleep laboratory (i.e. by adopting home ambulatory
monitoring) and for not collaborating patients.
Disclosure: The authors did not have conflicts of interest related to
the present work.
O55 | One year later: longitudinal effects of
flexible school start times on teenage sleep,
subjective benefits, and official grades
A.M. Biller1; C. Molenda1; G. Zerbini2; F. Obster3; C.
Förtsch4; T. Roenneberg1; E.C. Winnebeck1
1
Institute of Medical Psychology, Ludwig Maximilian University,
Munich; 2Department of Medical Psychology and Sociology, University
of Augsburg, Augsburg; 3Department of Statistics, Ludwig Maximilian
University, Munich, Germany; 4Biology Education, Ludwig Maximilian
University, Munich, Germany
Objectives/Introduction: Early school starts are a key reason for the
widespread sleep deprivation observed in teenagers worldwide. Apart
from posing health risks, insufficient sleep impairs learning and reduces
students’ career prospects. Whether delayed school starts can ease
this problem has been investigated mostly cross-­sectionally and via
low-­resolution or subjective measures. Hence, good evidence concern-
ing this potentially transformative policy measure is still scare.
Methods: We monitored sleep and official grades in a longitudinal pre-­
post design when a high school in Germany introduced a flexible start
system, allowing senior students to choose daily between 8 AM or
≥08:50 AM start. Sleep was assessed via daily sleep diaries for 3 weeks
at baseline, followed by 6 weeks in the flexible system (n = 65), and for
6 weeks after 1 year (n = 105; overlap n = 33). Official, quarterly grades
were obtained by 157 students over 4 years in 11 disciplines (n = 16,724).
Results: Longitudinal analyses showed that students maintained their
~1-­hour sleep gain on ≥08:50 AM-­days over 1 year in the flexible sys-
tem (p < 0.001). Students reported to feel more concentrated and mo-
tivated, and slept and learned better on ≥08:50 AM days (all p < 0.001).
Overall grades only improved in the flexible system when not adjusted
for covariates. In contrast, detailed mixed model analyses that adjusted
for covariates showed no grade improvement in the flexible system
(p > 0.05). Similarly, neither absolute values in chronotype, sleep dura-
tion, or social jetlag, nor their changes from the conventional to the
flexible system had any significant influence on grades (all p > 0.05), ex-
cept for social jetlag (p = 0.027). Robust effects were however found for
academic quarter, grade level, and academic discipline (all p < 0.001).
Conclusions: Improving sleep carries important implications for
learning and memory. Given the many contributing factors to school
grades, however, it may be an unwarranted expectation that bet-
ter sleep leads to immediate and substantial grade improvements.
Importantly, we found that grades did not worsen while students
benefitted psychologically from later starts and maintained their
sleep extension longitudinally. Future studies should track longer
changes in sleep and performance to disentangle the complex rela-
tionships between the multitude of players, and to add more high-­
quality evidence to this unresolved scientific and public debate.
Disclosure: Anna M Biller received a travel grant from the ESRS to
present other parts of this study and research and travel funds from
the Graduate School of Systemic Neurosciences Munich. Carmen
Molenda, Giulia Zerbini and Fabian Obster report no funding in rela-
tion to the study and outside the submitted work. Christian Förtsch
reports no funding in relation to the study and receiving funds from the
German Research Foundation (DFG), Joachim Herz Stiftung and a travel
grant from the LMU Excellence Grant outside the submitted work. Till
Roenneberg reports no funding in relation to the study and receiving
funding from the DAAD outside the submitted work. Eva C Winnebeck
reports during the conduct of the study receiving travel funds from the
German Dalton Society to present results of this study as well as from
the LMU Excellence Grant and Gordon Research Conference outside
the submitted work.
O56 | Comparison of surgical versus non-­
surgical therapies in the paediatric obstructive
apnea-­hypopnea syndrome
P. Martínez Ruiz de Apodaca1; M. Carrasco Llatas1; E.
Esteller Moré2,3
1
ENT, Hospital Universitario Doctor Peset, Valencia; 2ENT, Hospital
Universitari General de Catalunya, Sant Cugat del Vallès; 3Universitat
Internacional de Catalunya, San Cugat del Vallès, Spain
Objectives/Introduction: The treatment of choice for pediatric
OSAHS is surgical. However, its etiopathogenesis is multifactorial
ABSTRACTS
and is not always resolved with surgery. Therefore, other modalities
of treatment are used. The main objective is to know the efficacy
of surgery compared to other treatments. As secondary objectives,
the clinical characteristics and exploratory findings in relation to the
success/failure of the treatment are described.
Methods: Prospective cohort study with 323 children aged 1–14 years
and apnea-­hypopnea index (AHI) ≥3/h without previous treatment.
The treatment was organized into 4 categories: surgical (n = 201), med-
ical (n = 75), orthodontic (n = 6) and observation (n = 41).
Surgical treatment included; adenoidectomy + pharyngeal surgery
(tonsillectomy, tonsil reduction using different techniques, adenophar-
yngoplasty), medical treatment (topical corticosteroids, montelukast)
and orthodontic treatment (maxillary +/-­mandibular expansion).
Quality of life and sleep were assessed using two validated ques-
tionnaires (Pediatric Sleep Questionnaire & Esteller et al.) The upper
airway was explored, and nocturnal polysomnography (PSG) per-
formed in every patient. After 12 ± 3 months of treatment was com-
pleted, a new PSG and questionnaires were evaluated.
Results: The surgical group improved significantly both subjectively
and objectively. The mean AHI decreased from 7.95/ h to 2.57/ h
and the T 90 from 0.49 to 0 (p = 0.00). They improved significantly
(p < 0.05) in the 17 parameters of the Esteller et al. questionnaire, and
the PSQ spore changed from 0.49 to 0.22 (p = 0.00).
The AHI of the medical and orthodontic groups decreased by 4% and
7%, respectively. After medical treatment, significant improvement was
obtained in 6 of the 17 parameters and after observation or orthodontic
treatment in 3. The persistence after surgery was 31%, after medical
treatment 50%, after orthodontic 67%, and after observation 75%.
There were no differences in BMI between groups, and obesity
showed no relationship with OASHS persistence.
Tonsils grade 1–2 according to Friedman classification is related to
OSAHS persistence (p = 0.02). Other findings as narrow palate, longi-
tudinal cervicofacial morphology, or dental protrusion were not associ-
ated with OSAHS persistence.
Conclusions: Surgical treatment achieves the best results, however,
the 31% of those operated have persistence. Therefore, the sequential
treatment by combination of therapies could the appropriate strategy.
Disclosure: Nothing to disclose.
O57 | Infant habitual sleep and its association
with general development and socio-­cultural
environment in the first year of life
L.K. Gossé1; F. Wiesemann2; C. Elwell3; E. Jones1
1
Centre for Brain & Cognitive Development, Birkbeck, University of
London, London, United Kingdom; 2Research & Development, Procter
& Gamble, Schwalbach am Taunus, Germany; 3Department of Medical
Physics and Biomedical Engineering, Biomedical Optics Research
Laboratory, University College London, London, United Kingdom
|
      31 of 356
Objectives/Introduction: Sleep is crucial to an infants healthy devel-
opment. Parents are important contributors to both development of
sleep patterns and child development (Castro, 2015). Thus, infant sleep
may be influenced by their parents’ personal characteristics (e.g. cul-
ture, age, mental health or education). Here, we aim to disentangle how
infant habitual sleep (in particular good or poor sleep as measured by
sleep duration, longest sleep period or sleep fragmentation) and gen-
eral development are related to family socio-­cultural environment.
Methods: N = 76, 4–14 months-­old infants were studied for this study
that forms part of a longitudinal study (up to 4 study visits/participant,
N = 166 visits) exploring the relationship between sleep and early
neurocognitive development. Sleep measures included: Brief Infant
Sleep Questionnaire (Sadeh, 2004), 7-­day sleep diary and actigraphy
(w-­GT3X-­BT, ActiGraph). Ages & Stages Questionnaire (ASQ; Squires,
2009) assessed general development. Information on socio-­economic-­
status, maternal anxiety and depression (State Trait Anxiety Inventory
(Spielberger, 1999), Edinburgh Postnatal Depression Scale (Cox, 1987))
was recorded. Cluster (k-­means) analysis was used to identify good and
poor sleepers from the sleep data. Data were further analysed using
correlational and mixed effects analyses (Bonferroni-­corrected).
Results: Initial results on subjective individual sleep parameters and
socio-­cultural environment show that older parental age was associated
with shorter continuous periods of night sleep (e.g. rfathers = −0.341**)
and with larger variability in sleep fragmentation (rfathers = 0.274*).
Nap duration was negatively associated with number of bedrooms
(r  =  −0.255*) and positively with ASQ cognitive subscales (e.g. rProb-
lem-solving = 0.294**). Nap number was related to maternal education
(r = 0.268*). Further mixed model analyses on maternal mental health,
infant development and developmental trends in the sleep data in rela-
tion to parental characteristics are presented. Objective sleep meas-
ures are used to identify if parental traits affect infant sleep directly
or solely parental subjective experience of infant sleep. Differences in
socio-­cultural environment in poor and good sleepers (as identified by
cluster analysis) are discussed (*p < 0.05/** p < 0.01).
Conclusions: Socio-­cultural environment (ie. parental age or maternal
education) can affect infant sleep opportunities, a finding that has im-
plications for infant sleep interventions. Moreover, infant sleep, espe-
cially day sleep, seems to be related to infant cognitive development.
Disclosure: This project received funding from the EU HORIZON
2020 Research & Innovation Program under the Marie Sklodowska-­
Curie Grant Agreement 721895.
O58 | Clinical spectrum in pediatric narcolepsy
type 1: bad days, bad nights and late diagnosis
É. Herráez Sánchez; B. Pastor Romero; M. Sánchez Tornero;
M.J. Aguilar-Amat Prior; M. Naranjo Castresana; J. Oliva
Navarro; M. Merino Andreu
Hospital Universitario La Paz, Madrid, Spain
Objectives/Introduction: Narcolepsy is a chronic and disabling
disorder manifesting with excessive daytime sleepiness cataplexy,
 |
32 of 356       ABSTRACTS
hypnagogic or hypnopompic hallucinations, sleep paralysis, and dis-
rupted night-­time sleep, with two-­age peak of presentation: adoles-
cence and mild adulthood. However, there are important differences
between the clinical presentation and results of sleep studies in chil-
dren compared to adults, and must be considered to make an early
diagnosis and avoid as soon as possible the negative impact in qual-
ity of life due to narcolepsy diagnosis.
Objective: The aim of our study is to carry out a detailed description
of the clinical history and diagnostic tests in pediatric narcoleptic
patients in a referral Spanish Children's Sleep Unit.
Methods: Retrospective and descriptive study of clinical, laboratory
and polysomnographic features in a group of 30 narcoleptic patients,
aged 7–18 years, 60% girls. We assessed demographic and clinical data
and completed specific scales and questionnaires. Night-­time PSG and
MSLT were performed in all patients (including quantification of diurnal
REM and NREM duration in MSLT or N1/W transitions to REM in PSG).
HLA-­DQB1*0602 typing, blood test including ASLO and cerebrospinal
fluid hypocretin-­1 measurements were also conducted.
Results: In this sample, pediatric narcolepsy was associated with comor-
bidities including weight gain/overweigh (50%), attention deficit (97%),
previous ADHD diagnosis (10%), depression (23.3%) or eating attacks
(23.3%) but precocious puberty was rare (1 case). Disrupted night-­time
sleep was quiet frequent (21.7 ± 15 arousal/h, 46.4 ± 20.5 awakenings/
night, Wake/N1 Index 5.0 ± 3.2 or referred parasomnia in 76.6%, with-
out SBD or PLMS). In MSLT, 4 or 5 SOREMp, as long as 14.5 min, were
present in 56.6% of patients. Nevertheless, narcolepsy diagnosis arrived
more than 3 years after first symptoms. Low Hypocretin in CSF was
detected in all tested patients except one of them (Prader-­Willy syn-
drome). HLA typing was negative in 4 cases (but cataplexy was present).
Conclusions: In paediatrics, narcolepsy type 1 is a very disabling
disorder, with a chronic course and lifelong handicap in daily activi-
ties that cause what teens describe as ‘dreadful life’. In spite of frag-
mented nocturnal sleep, parasomnias or frequent and long-­lasting
daily naps, narcolepsy is usually diagnosed several years later, con-
tributing to negative quality of life.
Disclosure: Acronyms: PSG: Polysomnography MSLT: Multiple
Latency Sleep Test ADHD: Attention deficit hyperactivity disorder
SBD: Sleep Breathing Disorders PLMS: Periodic Leg Movements
during sleep CSF: Cerebrospinal fluid ASLO: Antistreptolysin O titre
Nothing to disclose.
O59 | Does your baby have a sleep problem?
Auto-­videosomnography determinants of parent
perceived infant sleep problems
M. Kahn1; N. Barnett2; A. Glazer2; M. Gradisar1
1
Flinders University, Adelaide, SA, Australia; 2Research Department,
Nanit, New York, NY, United States
Objectives/Introduction: Seeking professional help to improve in-
fant sleep is usually based on parental beliefs that their child has
a sleep problem. Such perceptions may be influenced not only by
realistic aspects of the child's sleep, but also by parents’ behaviours
and emotions. This study tested which objective infant sleep meas-
ures and parent factors were most potent in predicting parent per-
ceptions of a sleep problem, using auto-­videosomnography within a
large sample of infants.
Methods: Parents of 946 infants (46% girls) aged 2 weeks to
18 months participated in this cross-­sectional study. Infant sleep
and parents’ nighttime crib visits were measured objectively using
auto-­videosomnography for 14 consecutive days in the naturalistic
home-­setting. Perceived infant sleep problems, parent depression
levels, cry tolerance and demographic characteristics were reported
by parents in an online survey.
Results: Logistic regression analyses revealed that the factor most
strongly associated with perceived infant sleep problems was pa-
rental nighttime crib visits, as every additional visit was associated
with a 31% increase in odds of parent-­defined infant sleep problems
(Wald = 32.68, p < 0.001, OR = 1.31, 99%CI: 1.16, 1.48). This was
followed by decreased sleep duration (Wald = 30.34, p < 0.001,
OR = 0.58, 99%CI: 0.45, 0.75), low cry tolerance (Wald = 17.32,
p < 0.001, OR = 0.69, 99%CI: 0.46, 0.89), greater parental depres-
sion levels (Wald = 9.68, p = 0.002, OR = 1.06, 99%CI: 1.01, 1.12) and
early sleep offset time (Wald = 9.17, p = 0.002, OR = 0.70, 99%CI:
0.55, 0.95). Minor differences were recorded between determinants
of maternal compared to paternal perceptions.
Conclusions: The results of the present study revealed that the most
potent predictor of perceived infant sleep problems was an aspect
of parental – rather than infant – behavior. Researchers, clinicians
and parents should be aware of the major role parental behaviours
play in infant sleep problem perception, which in turn may determine
whether or not they choose to seek treatment for these problems.
Disclosure: Funding: This study was supported by Nanit. Conflict
of interest statement (a) Financial Disclosure: MG has served a Pro-­
Bono consultant for Nanit. NB and MK have served as consultants
for Nanit. AG was an employee of Nanit at the time of study imple-
mentation. (b) Non-­financial Disclosure: none.
ABSTRACTS
TH E DY N A M I C S O F R E M S LE E P I N
E M OTI O N R EG U L ATI O N A N D I N S O M N I A
O60 | Restless REM sleep in insomnia disorder
and its detrimental effects on regulation of
emotional distress
R. Wassing1,2,3; O. Lakbila-Kamal3; J.R. Ramautar3; D.
Stoffers3,4; F. Schalkwijk5; L.M. Talamini5; E.J.W. Van
Someren3,6,7
1 2
Woolcock Institute of Medical Research; Central Clinical School,
University of Sydney, Sydney, NSW, Australia; 3Sleep and Cognition,
Netherlands Institute for Neuroscience; 4Spinoza Centre for
Neuroimaging; 5Faculty of Social and Behavioural Sciences, University
of Amsterdam; 6Psychiatry, Amsterdam UMC; 7Department
of Integrative Neurophysiology, VU University, Amsterdam, The
Netherlands
Introduction: Insomnia, depression and anxiety are the top-­3 most
burdensome mental disorders. Insomnia disorder is highly co-­morbid
with and can exacerbate depression and anxiety. Furthermore, these
disorders share considerable overlap in the polysomnographically
assessed markers of sleep disruptions. These disruptions relate es-
pecially to NREM and REM sleep features important for reprocess-
ing of emotional memories.
Aims: In a set of neuroimaging studies, we first explored the hypoth-
esis that sleep disruptions in insomnia hamper overnight reprocess-
ing of emotional memories. Secondly, we sought further support for
the idea that insomnia disorder may involve a lasting deficiency to
downregulate emotional distress.
Methods: We used functional MRI in insomnia disorder and normal
sleepers to identify the brain activation patterns in response to novel
and relived shameful emotional experiences. These assessments
were repeated after a polysomnographically recorded night of sleep.
Results: The limbic response to the novel emotional experience
decreased overnight in proportion to the total duration of consoli-
dated REM sleep and NREM sleep spindles. Restless REM sleep,
in contrast, impeded overnight adaptation of this limbic response.
Furthermore, in normal sleepers, reliving of shameful experiences
from the distant past did not elicit a limbic response. In contrast,
participants with insomnia disorder recruited overlapping parts of
the limbic circuit, in particular the dorsal anterior cingulate cortex,
during both novel and relived shameful experiences.
Conclusions: The findings reveal a maladaptive type of sleep, char-
acterized by awakenings and arousals during REM sleep, that ham-
pers overnight regulation of emotional memories. This distress may
accumulate and explain why insomnia disorder involves a deficiency
to dissociate the limbic circuit from emotional memory traces of the
distant past. Restless REM sleep may be a target for interventions in
mental disorders.
Disclosure: Nothing to disclose.
|
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O61 | Insomnia disorder subtypes and the role
of hyperarousal
T.F. Blanken1,2; J.S. Benjamins3; D. Borsboom2; J.K.
Vermunt4; E.J.W. Van Someren1,5,6
1
Sleep and Cognition Department, Netherlands Institute for
Neuroscience, an Institute of the Royal Netherlands Society for Arts
and Sciences; 2Psychological Methods, University of Amsterdam,
Amsterdam; 3Sociale Wetenschappen, Utrecht University, Utrecht;
4
Methodology and Statistics, Tilburg University, Tilburg; 5Integrative
Neurophysiology, Center for Neurogenomics and Cognitive Research
(CNCR), VU University Amsterdam; 6Amsterdam UMC, Vrije
Universiteit, Psychiatry, Amsterdam Neuroscience, Amsterdam, The
Netherlands
Background: Insomnia is the second most prevalent psychiatric dis-
order. Despite this high prevalence, the underlying mechanisms and
characteristics of insomnia are often inconsistent, indicating possi-
ble heterogeneity. We investigated whether different types of in-
somnia exist, which are not necessarily reflected in specific sleep
complaints, but in stable characteristics such as personality traits
and life history.
Methods: N = 2224 volunteers of the Netherlands Sleep Register
with insomnia completed up to 34 questionnaires about factors that
proved to be important for insomnia, such as their life history, cogni-
tion, affect and personality. Using latent class analysis, we identi-
fied data-­driven subtypes of insomnia. We evaluated their clinical
relevance and stability over years, and the robustness of the five
classes in a new population. We used machine learning techniques
to select a minimal set of questions to measure the subtypes and
assessed its accuracy.
Results: The insomnia diagnosis includes at least five different sub-
types that are reflected in a multivariate pattern of stable charac-
teristics: (1) highly distressed, moderately distressed (2) reward
sensitive or (3) reward insensitive, low distressed with (4) high or
(5) low reactivity. The five types proved robust over 4.8 ± 1.6 years
of follow-­up, and in an independent sample. Crucially, the subtypes
differed up to a factor five in the incidence and prevalence of de-
pression, in the development of their sleep complaints, and in the
self-­
reported effects of benzodiazepine use. Subtypes differed
with respect to profiles of hyperarousal-­related measures. A sub-
set of questions proved to be accurate and was implemented in the
Insomnia Type Questionnaire (ITQ).
Conclusion: This large-­scale study identified five robust and clinically
relevant subtypes of insomnia. Through the ITQ, freely available on-
line, the subtypes can be measured easily, accurately and fully auto-
mated. By reducing unrecognized heterogeneity, we have more power
to detect robust subtype-­specific mechanisms, for example pertaining
to hyperarousal and depression. Subtyping thus enables patients, re-
searchers and clinicians to clarify inconsistencies in underlying mecha-
nisms and treatment effects to ultimately optimize treatment.
Disclosure: Nothing to disclose.
 |
34 of 356       ABSTRACTS
O62 | Probing the perception of sleep –
auditory event-­related potentials in insomnia
B. Feige; C. Baglioni; P. Boehm; A. Heinrich; S. Trumm; F.
Benz; L. Frase; D. Riemann
Department of Clinical Psychology and Psychophysiology, Medical
Center, University of Freiburg, Freiburg, Germany
The complaint of not receiving the full recuperation from a night's
sleep is central to insomnia. Since differences in polysomnographi-
cally derived sleep duration are modest in comparison, some quality
of sleep must be modified in insomnia which often evades standard
polysomnography. Particularly, modified REM sleep quality has been
found associated with insomnia complaints. Still, quantitative cor-
relates of this modified sleep quality are scarce.
One possible hypothesis for the cause of insomnia complaints
is that patients may be more sensitive to inevitable stimuli occur-
ring during the night, causing small sleep disruptions with memory
traces which could be perceived as waking time. In a previous awak-
ening study, we did not find reduced waking thresholds in insomnia.
However, secondary mechanisms could prevent awakening even if
earlier processing stages would be modified.
In the current study, we therefore examined auditory event-­
related potentials to four relatively low intensity (50 dB SPL) synthe-
sized guitar tones forming the C major chord C, E, G and C’, played
continuously throughout bed time. Two standard nights in the sleep
lab were followed by two more nights with this stimulation. Matched
groups of 50 patients with insomnia disorder (ID, without comor-
bidities) and 50 good sleeper controls (GSC) were examined. After
artifact detection and ICA-­based removal of vertical and horizon-
tal electrooculogram (EOG) contamination, event-­
related poten-
tial averages were obtained for each sleep stage. Phasic and tonic
REM sleep were classified using the EOG and treated as separate
stages. Latencies and amplitudes of components P1 (P50), N1 and
P2 were measured and analyzed by multivariate repeated-­measures
ANCOVA including effects of group, night and age.
While there were no group differences for any of the event-­
related components, the subjective-­objective wake time difference,
indexing the amount of wake perception during sleep, was signifi-
cantly related to reduced P2 latencies in sleep stages N1 and tonic
REM. Our results indicate that sensitivity to stimuli is not modified
in insomnia as a group but rather that it is related to the amount of
wake perception during sleep. In these ID patients, targeting ‘watch-
fulness’ often coupled with negative expectations and emotions
could be an important treatment option.
Disclosure: Nothing to disclose.
O63 | Modulation of distress by targeted
memory reactivation in REM and NREM sleep in
healthy adolescents
A.-K. Pesonen; R. Halonen; L. Kuula
Research Program Unit, Faculty of Medicine, University of Helsinki,
Helsinki, Finland
Introduction: Sleep is associated with memory formation and for-
getting, also for emotional memories and in relation to emotional
reactivity. Less is known whether this process can be manipulated by
introducing targeted memory reactivation (TMR) with cued sound
stimuli presented during sleep.
Objectives: We investigated whether the reactivity to an induced
social shame in the evening decreases over night, and whether TMR
with cued sounds is associated with changes in physiological reactiv-
ity to shameful experience.
Methods: 30 participants sang Abba's Dancing Queen and listened
to their singing from an isolated vocal track in the evening (twice) and
in the morning. Listening was cued with blue noise. The participants
were randomized into TMR in REM, TMR in non-­REM and non-­TMR
groups, blue noise being played in respective sleep stages. The par-
ticipants filled in the Test of Self-­Conscious Affect (TOSCA-­3) ques-
tionnaire and their skin conductance response (SCR) were measured
while listening to their singing.
Results: Both in REM-­TMR and non-­TMR groups the SCR to listening
to own singing increased slightly from evening to morning. In non-­
REM-­TMR there was a slight decrease in reactivity (11%), but none
of the changes were statistically significant. In those with a higher
dispositional sensitivity to self-­conscious affect (TOSCA3-­shame),
the SCR to listening was larger.
Conclusions: The experimental setting, being a modification from
Wassing et al. karaoke paradigm, evoked self-­reported and physi-
ological stress in participants. However, the current piloting study
did not find support for the efficiency of TMR in over night emotion
regulation, but suggests that dispositional sensitivity to experience
shame may be an important factor to take into account in TMR stud-
ies focusing on emotion regulation.
Disclosure: Nothing to disclose.
ABSTRACTS
U N D E R S TA N D I N G TH E M EC H A N I S M S
O F D O PA M I N E RG I C N O N - ­R E S P O N S E I N
R E S TLE S S LEG S S Y N D RO M E: A S E A RC H
I NTO A LTE R N ATI V E TR E ATM E NT
A PPROAC H E S
O64 | Brief introduction: augmentation of RLS
symptoms: the scope of the problem
D. Garcia-Borreguero
Sleep Research Institute, Madrid, Spain
Although dopamine agonists have been considered for some time
to be the first-­line treatment choice for the treatment of RLS/WED,
there is growing concern about the extent of treatment failure dur-
ing long-­term treatment. Indeed, various retrospective studies have
found a prevalence of non-­response at approximately 60% following
the first 8 years of treatment with dopaminergic agents. The main
cause of treatment failure is augmentation, whereby symptoms be-
come worse than they were before treatment initiation. In fact, aug-
mentation reflects a profound change in the pathophysiology of RLS
by which agents that were initially alleviating symptoms, become
exacerbators of the latter.
The Symposium will discuss current clinical and scientific knowl-
edge on this problem and discuss therapeutic alternatives.
Disclosure: Dr. G.-­B. has received a research grant from Merck, with
no relation to the topic of this talk.
O65 | Altered dopamine receptor phenotype in
an animal model of augmentation
S. Clemens
Physiology/Brody School of Medicine, East Carolina University,
Greenville, NC, United States
Restless Legs Syndrome (RLS) is a highly prevalent chronic senso-
rimotor and sleep disorder that severely affects quality of life and
usually requires lifelong treatment. Identified by patient-­subjective
sensory features, RLS is often associated with periodic leg move-
ments during sleep (PLMS). Dopamine (DA) receptor agonists, in par-
ticular those targeting the D3 receptor subtype (D3R), have shown
fast and significant relief from RLS and PLMS symptoms. However,
over timeD3R drug treatment therapies fail to maintain their effi-
ciency and eventually lead to a worsening of the symptoms (aug-
mentation). This augmentation is the single-­largest side effect of
DA-­based therapies, and the mechanism that switches the treatment
outcome has not yet been identified. The rodent spinal cord ex-
presses both excitatory D1Rs and inhibitory D3Rs. D3R expression
is relatively low in the ventral horn, while D1Rs are highly expressed
|
      35 of 356
in motoneurons, and activation of D1Rs can drive spinal network ac-
tivation and the generation of corresponding rhythmic movements.
D1Rs and D3Rs can form functional G protein-­coupled interacting
heteromers that modulate excitability, and D3Rs can modulate the
activity of the dopamine reuptake transporter (DAT), which can alter
DA levels and thus synaptic-­mediated excitation in the cord. We have
mimicked the decline of the D3R agonist efficacy in mice and found
that blocking Gs-­coupled D1 receptors (D1Rs) at this stage led to a
return of function and restored the initial effects D3R agonist treat-
ment. Therefore, we here present a new model that accounts for the
initial decrease in the DA-­based treatment success, and we propose
a new non-­obvious pharmacological approach that can maintain and
restore DA-­based treatment outcomes for RLS and PLMS.
Disclosure: East Carolina University has submitted a patent applica-
tion on behalf of SC that addresses the role of dopaminergics in RLS.
O66 | The role of brain iron deficiency in
therapeutic non-­response
C. Garcia-Malo
Sleep Research Institute, Madrid, Spain
As it is well-­known, brain iron deficiency is the most consistent bio-
logical finding in restless legs syndrome. To date, iron replacement
therapy should be considered among the first-­line therapeutic op-
tions, administered orally or intravenously, when inside the cut-­off
points for safety. However, despite of it, we find that a consider-
able number of patients are still ‘non-­responders’ to this treatment.
The main hypothesis is that, in non-­responders, brain iron deficiency
can not be reversed, despite the correct treatment. We will describe
the role of transcranial sonography, a neuroimaging technique that
enable us the direct quantification of iron deposits located in the
substantia nigra. We will also present our results regarding the use-
fulness of transcranial sonography as a predictor of clinical outcome
after iron replacement therapy, with special emphasis on those pa-
tients defined as non-­responders.
Disclosure: Nothing to disclose.
O67 | Targeting glutamatergic and
adenosinergic dysfunction
D. Garcia-Borreguero
Sleep Research Institute, Madrid, Spain
Increasing evidence suggests that, in addition to dopaminergic
pathways, glutamatergic and adenosine-­related mechanisms might
be playing too an important role in the pathophysiology. For exam-
ple, thalamic glutamatergic activity has been demonstrated to be
increased in RLS patients (Allen et al., 2013), which could produce
 |
36 of 356       ABSTRACTS
hyperarousal associated with increased waking during sleep, mostly
affecting non-­REM sleep and not related to PLMS (Ferri et al., 2010,
Manconi et al., 2012). And recent data on brain iron-­deficient rodents
suggest that adenosine A1 receptor downregulation might play a key
role in PLMS and hyperarousal (Quiroz et al, 2016). The alterations in
adenosine-­mediated modulation of dopamine and glutamate neuro-
transmission may be fundamental in the elicitation of the full range
of RLS symptoms, with dopamine more related to sensory symptoms
and PLMS and glutamate more related to the RLS hyperarousal with
sleep disruption. Furthermore, chronic sleep loss induces by itself
changes in these neurotransmitters that could further worsen dis-
ease severity. Indeed, a decrease in arousal might be the mechanism
by which a number of drugs improve RLS. These interactions be-
tween adenosine, glutamate and dopamine lay the ground for future
treatments for RLS/WED. The talk will review current knowledge on
the role of glutamate and adenosine in the regulation of arousal in
RLS, and also present a new, previously unpublished, controlled trial
on the role of the adenosinergic agent dipyridamole in RLS.
Disclosure: Dr-­Garcia-­Borreguero has received a research grant
from Merck, not related to the content of this talk.
O68 | Opioid treatment of RLS: degree, doses,
differences, mechanisms, receptors
R.P. Allen
Neurology, Johns Hopkins Univ., Baltimore, MD, United States
Although opioids were the first treatments used for RLS they have
since the introduction of dopaminergic treatment become less used
and their relative efficacy, mechanisms of action and the role of re-
ceptor versus duration of action is poorly understood. Opioid treat-
ment is generally considered very effective, however in controlled
studies the treatment was not effective for: 20% (2 of 11) of general
RLS patients on oxycodone titrated to efficacy (maximum 25 mg/
day), and 19% ( 30 of 154) of RLS patients failing prior dopaminergic
treatments, but in that study 13% of the failures were from prob-
lems tolerating the medication. These efficacy rates compare well
with other medication treatments, but do not clearly indicate better
efficacy for opioids compared to other treatments. The success of
opioid treatment after failure with dopaminergics may relate to un-
detected ubiquitous dopaminergic RLS augmentation. Augmentation
is a slowly progressive problem gradually producing changes in the
dopaminergic-­RLS interactions occurring before symptoms of aug-
mentation appear. Nonetheless clinical experience indicates opioids
do better than the alpha-­2-­delta agents for successful treatment of
augmentation.
The reported effective doses for opioids are generally in the
range used for analgesics except for methadone which for unclear
reasons is effective at very low doses. This may reflect receptor dif-
ferences, particularly methadone effect on NMDA receptors or it
may have some relation to duration of efficacy, although long acting
oxycodone required doses in the analgesic range.
The mechanism producing benefit for RLS is somewhat unclear.
There is limited data indicating RLS related changes in opioid recep-
tors, but these seem hardly adequate to explain treatment efficacy.
Recent studies demonstrate opioid effects on dopaminergic systems
that include complex considerations of opioid receptor heteromers
brain regional differences that for methadone leaves intact pre-
sumptive dopamine mechanisms of efficacy but reduces the effects
on dopaminergic systems related to euphoria and dependence.
Opioid effects on the dopaminergic system appear adequate to
dampen residual effects of augmentation and provide a generally
effective long-­term treatment for RLS. Their limits include depen-
dence problems, major adverse psychological and medical effects
and efficacy failure for 7 to 20% of RLS patients.
Disclosure: Nothing to disclose.
S LE E P OS C I LL ATI O N S : A N E W PE R S PEC TI V E
O N TH E D E V E LO PM E NT A N D D EC LI N E O F
H U M A N CO G N ITI O N
O69 | A lifespan perspective on sleep and
memory: potentials and challenges
M. Werkle-Bergner; A.-K. Joechner; B.E. Muehlroth
Center for Lifespan Psychology, Max Planck Institute for Human
Development, Berlin, Germany
Both, sleep and memory functions change tremendously from child-
hood to old age. Maturation, experience, and senescence exert inter-
active forces in sculpting the relations between sleep and memory.
Hence, uncovering how developmental changes in brain structure
and neurochemistry affect changes in sleep physiology and its rela-
tion to memory functions, requires novel experimental designs and
analysis techniques able to disentangle within person change from
between person differences. On the basis of electrophysiological
sleep and structural brain data, we will discuss methodological core
challenges in the study of sleep and lifespan development. Mainly,
we will argue that uncovering age-­
dependent alterations in the
physiology of sleep requires the development of adjusted and indi-
vidualized analytic procedures that filter out age-­independent inter-
individual differences. Age-­adapted methodological approaches are
thus required to foster the development of valid and reliable bio-
markers of age-­associated cognitive pathologies.
Disclosure: Nothing to disclose.
ABSTRACTS
O70 | Spindle oscillatory-­quality: a new metric
for the spatiotemporal dynamics of sleep spindles
C. Blanco-Duque1; M.C. Kahn1; L.B. Krone1; P.
Achermann2,3; D.M. Bannerman1; E. Olbrich4; V.V.
Vyazovskiy1
1
University of Oxford, Oxford, United Kingdom; 2The KEY Institute for
Brain-­Mind Research; 3University of Zurich, Zurich, Switzerland; 4Max
Planck Institute for Mathematics in the Sciences, Leipzig, Germany
Introduction: Sleep spindles are transient 10–15 Hz oscillations in
field potentials occurring during NREM sleep. Due to their impor-
tant role in normal and impaired brain function, sleep spindles have
become an attractive target for neuro-­modulation. To manipulate
and study spindles effectively, however, it is necessary to develop
detection methods that account for their complex spatiotemporal
dynamics.
Methods: To this end, we fit autoregressive models to EEG and LFP
signals, recorded from either somatosensory or motor brain cortices
of adult male C57BL6 mice (n = 14), as well as adult GRIA1-/- mice
-/-
(n = 7) and wild-­type (n = 6, WT) littermates. GRIA1 mice show
a genotype and behavioural phenotype relevant for schizophrenia.
We detected spindles (10–15 Hz) based on the level of damping in
the signal. Detected spindles varied with respect to their strength of
damping, which we used as a measure of spindle oscillatory-Quality
(oQ1-­oQ5 = strong-­to-­weak damping corresponding to low-­to-­high
oQ).
Results: We found that low-­
oQ spindles occur at a higher rate
(F4,40 = 98.6, p < 0.001, mixed ANOVA) but show reduced duration
(F4,40 = 237.9, p < 0.001, mixed ANOVA) relative to high-­oQ spindles.
Furthermore, low-­oQ spindles are more local than high-­oQ spindles
(encompassing oQ1 = 37 ± 0.2% vs oQ5 = 77 ± 0.07% of all LFP chan-
nels), and LFP oQ significantly predicts the spindle power density
in the EEG (x 24 = 11.47, p  < 0.05). Notably, the majority (~91.7%)
of local LFP spindles remain undetected at the EEG level. We also
found that the spindle oQ was significantly associated with the oc-
currence of LFP slow waves (0.5–4 Hz) (x 24 = 10.13, p < 0.05), and
spindle oQ increases after sleep deprivation compared to baseline
sleep (F1,13 = 11.29, p < 0.005, ANOVA). Finally, we found that GRIA1-
/-
show reduced EEG spindles relative to WT mice (F1,12 = 17.62,
p < 0.001, ANOVA), while their local LFP spindles remained present
(F1,12 = 0.314, p = 0.59, ANOVA), albeit with lower oQ.
Conclusions: Our results suggest that spindles do not represent
strictly local or global events, but rather show a progressive vari-
ability in their spatio-­temporal dynamics, which is captured in their
oscillatory-Quality. We propose that taking into account this param-
eter and developing experimental tools targeted at manipulating the
spindle oscillatory-Quality may provide novel insights into the bio-
logical function of spindles in both health and disease.
Disclosure: Nothing to disclose.
|
      37 of 356
O71 | Slow oscillations in children and their
potential as neurodevelopmental marker
S. Kurth
Department of Psychology, University of Fribourg, Fribourg, Switzerland
Research using high-­density EEG during sleep have doubled in num-
ber across the past decade. This method has also opened a new av-
enue in the developmental domain: with the observation of regional
EEG patterns in children and adolescents the transitions in neurode-
velopment are becoming visible – and quantifiable.
First, new findings on spatio-­temporal properties of slow waves
will be presented. The patterns how slow waves propagate across
the scalp undergo modifications across development: in children,
scalp slow waves originate centro-­parietally and by adolescence they
emerge predominantly frontally. In accordance with the concept that
slow waves could modify neuronal connectivity, it will be discussed
whether the slow waves actively convey the neuronal developmen-
tal processes that characterize brain development. The potential risk
of ‘poor sleep’ for the developing brain will be evaluated.
Second, further promising markers in the sleep EEG will be dis-
cussed in the context of their clinical application.
Third, new insights and directions in infant sleep research will
be presented, for example automatic sleep stage detection and its
improved performance due to high-­density EEG.
Disclosure: Nothing to disclose.
O72 | Network oscillations of the sleeping
brain: the (patho-­) physiology of human memory
systems
R. Helfrich
Hertie-­Institute for Clinical Brain Research, University of Tuebingen,
Tübingen, Germany
The precisely timed interaction of specialized but widely distributed
cortical regions constitutes the neural basis of sleep-­
dependent
memory formation. However, it is still largely unknown how the
brain self-­organizes information processing, transfer and storage.
Neural oscillations have been proposed to constitute a flexible in-
trinsic timing mechanism to route information flow between neu-
ronal ensembles. In particular, non-­
rapid eye movement (NREM)
sleep is dominated by prominent oscillations, which coordinate the
hippocampal-­neocortical dialogue. Contemporary models generally
assume that hippocampal ripples trigger spontaneous memory con-
solidation. Here, I discuss an updated model, where the neocortex
orchestrates information reactivation during sleep to ensure that
transfer occurs when cortical processing capacities are optimal.
In particular, I will discuss how the precise temporal coordination
between the hippocampus and the prefrontal cortex subserves
 |
38 of 356       ABSTRACTS
memory formation, i.e. the reactivation, transfer and consolidation
of newly acquired information. Second, I will address how different
neurological diseases that are typically accompanied by memory
deficits, are characterized by specific temporal alterations of the
sleep architecture. I will demonstrate that different disorders exhibit
distinct ‘fingerprints’ that can be detected automatically to guide
clinical evaluation and targeted treatment. Hence, temporal disper-
sion of precise network organization provides a novel pathway of
age-­and disease-­related cognitive decline. Third, I will outline how
impaired network coordination could constitute a novel therapeutic
target for non-­pharmacological interventions. In particular, I will dis-
cuss that temporal network coordination might be enhanced through
frequency-­specific neurostimulation, which selectively targets the
aberrant ‘fingerprints’ and thereby, could alleviate memory deficits.
Disclosure: Nothing to disclose.
O R A L 9 – C H RO N O B I O LO G Y & C I RC A D I A N
DISORDERS
O73 | Learning management system logins at
a large university show that late type students
have poorer grades irrespective of class start
time
S.C. Yeo1; C. Lai2; J. Gooley1,2
1
Neuroscience and Behavioural Disorders Programme, Duke-­NUS
Medical School; 2Institute for Applied Learning Sciences and
Educational Technology, National University of Singapore, Singapore,
Singapore
Objectives/Introduction: Late chronotype has been shown to as-
sociate with poorer academic achievement. However, most find-
ings in university students are based on small convenience samples.
Recently, it was shown that chronotype can be derived from Learning
Management System (LMS) login behaviour (Smarr and Schirmer, Sci
Rep, 2018;8(1):4793). We used this method at a large university to
test the hypothesis that late type students show poorer academic
performance compared with their peers across different class start
times.
Methods: Deidentified data were analysed for 31,705 undergradu-
ates over 5 semesters at the National University of Singapore (52%
Female; Mean age ± SD = 22.9 ± 2.4 years). Students were assigned
to different chronotype categories (early, intermediate, late) based
on their median login phase of LMS activity on non-­school days de-
termined by circular statistics. Early and late types were defined as
students whose median login phase was more than one standard de-
viation below or above the group median (11% and 15% of the sam-
ple, respectively). Grades were examined for 5,797 course modules
with class start times ranging from 0800 to 1800 in hourly intervals.
ANOVA was used to compare cumulative grade point average (GPA)
between chronotype categories, and to compare grades for classes
with different start times.
Results: There was a significant association between chronotype
and grades (F = 63.7, p < 0.001), in which GPA was lower in late
type students compared with early and intermediate type students.
When grades were sorted by class start times, late type students
performed more poorly for all class start times (p < 0.05 for all pair-
wise comparisons).
Conclusions: The LMS chronotype method can be used to derive
chronotype for large samples of university students without requir-
ing their active participation. Consistent with prior work (Smarr and
Schirmer, 2018), evening type students showed poorer academic
performance irrespective of class start time. Future studies should
investigate factors that may give rise to poorer academic achieve-
ment in late type students, including differences in sleep, mood, per-
sonal characteristics, and class attendance.
Disclosure: The authors have no conflicts of interest to declare.
The work was supported by funding provided by the NUS Office
of the Senior Deputy President & Provost and the NUS Institute for
Applied Learning Sciences and Educational Technology.
O74 | Melatonin might influence the circadian
regulation of the retina in patients with REM
sleep behavior disorder
O. Steiner1; J. de Zeeuw1,2; S. Stotz1,2; F.W. Bes1,2; D. Kunz1,2
1
St. Hedwig-­Hospital, Clinic for Sleep & Chronomedicine; 2Charité-­
Universitätsmedizin Berlin, Corporate Member of Freie Universität
Berlin, Humboldt-­Universität zu Berlin, and Berlin Institute of Health,
Institute of Physiology, Sleep Research & Clinical Chronobiology, Berlin,
Germany
Objectives/Introduction: REM sleep behavior disorder (RBD) is a
parasomnia characterized by a loss of muscle atonia during REM
sleep. Although there is evidence that treatment with melatonin has
a positive effect on RBD symptom severity, the mode of action is
not (fully) understood. To investigate if melatonin has a beneficial
effect via re-­entrainment of the circadian system we used chromatic
pupillometry by examining the pupillary light reflex (PLR) in response
to blue light. A recent study demonstrated that the PLR in response
to blue light is impaired in patients with Parkinson disease (Joyce,
2018). As RBD is a harbinger of synucleinopathies we expected an
impaired PLR in patients with RBD which might be improved after
the continuous intake of melatonin.
Methods: In order to minimize circadian influence, pupil measure-
ments were taken in the morning/early afternoon (8:30 a.m. to
3:00 p.m.). Patients underwent a dim-­light condition (10-­min dark
adaption). Sessions included two 1-­s light pulses (pulse 1: 56 cd/m2;
pulse 2: 170 cd/m2) and 15 s recording after each light pulse. A blue
light stimulus with a wavelength of 480 nm and frequency of 67 Hz
was used. Next to the baseline pupil size (BPD), the minimum pupil
ABSTRACTS
size (MPS) and the post-­illumination pupil response (PIPR) 6 s after
the light pulse were determined and analyzed relative to baseline.
Melatonin was taken half an hour before habitual bedtime and al-
ways at the same clock time for at least half a year.
Results: In a retrospective analysis, the PLR of 38 RBD-­patients
was compared pre and post-­treatment with exogenous melatonin
(6f-­
24m). Results showed a significant improvement in the PIPR
(p = 0.003) and MPS (p = 0.046) in response to an intense blue light
stimulus after intake of melatonin. Melatonin did not affect the BPD
(p = 0.45).
Conclusions: Our results indicate that melatonin might influence
the sensitivity of the retina by its actions on the circadian system.
Findings are consistent with an impaired circadian system in RBD,
and with a restoration effect by melatonin.
Disclosure: Nothing to disclose.
O75 | Blue enriched white light exposure
during 40 hours of extended wakefulness does
not alter recovery sleep in healthy young adults
1 1,2 1,2 1,2
R. Glacet ; E. Reynaud ; Ü. Kilic-Huck ; L. Hugueny ; C.
Siegrist2; E. Peiffer2; V. Roy De Belleplaine2; C. Bopp2; H.
Comtet1,2; P. Bourgin1,2
1
CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences;
2
Sleep Disorders Center & CIRCSom (International Research Center
for ChronoSomnology) – Strasbourg University Hospital, Strasbourg,
France
Objectives/Introduction: Sleep deprivation (SD) is a major public
health issue. Light exposure is known to have an alerting effect able
to counteract adverse consequences of sleep deprivation, but its
impact on recovery sleep remains unclarified. We conducted con-
stant routine protocols to investigate the effects of light exposure
on recovery sleep following extended sleep deprivation in healthy
subjects.
Methods: 64 healthy young adults were randomized in 4 groups
(n = 16 each) and underwent a baseline night (8 h; 0 lux), a 40 h con-
stant routine protocol and a recovery night (at least 8 h; 0 lux). During
the 40 h, 2 groups alternated wake (150 min) either in DL (<8 lux) or
BEL (250 lux) and nap periods (75 min; 0 lux). 2 groups were sleep
deprived and exposed either to constant DL or alternating BEL and
DL periods (150/75 min). A continuous polysomnographic recording
was performed during the whole protocol.
Results: During the recovery night after SD the subjects slept longer
(p < 0.001), displayed a higher amount of N3 (p < 0.001), a lower
amount of N2 (p < 0.001) and N1 (p < 0.01 for DL and p < 0.001 for
BEL), a lower micro-­arousal index (p < 0.001 for DL and p < 0.01 for
BEL) and less sleep stage changes (p < 0.05), compared to the base-
line night. Sleep latency was higher after naps (p < 0.05 for DL and
p < 0.001 for BEL) but not after SD. N3 latency was higher after naps
under DL (p < 0.001) but not under BEL. BEL has extended sleep
|
      39 of 356
latency during recovery night following naps (p < 0.001), but not in
the SD group under high homeostatic pressure (p < 0.001) (n = 16
per group, except Naps + DL group during recovery night n = 15).
Conclusions: We observed that high homeostatic pressure in-
creased the depth and quality of recovery sleep whereas low sleep
pressure rather decreased it. Most importantly we highlighted that
blue enriched white light exposure during the 40 h of extended
wakefulness did not alter recovery sleep. These results provide new
insights on the interaction between the homeostatic process and
the direct photic regulation of sleep with direct societal and clinical
applications.
Disclosure: Nothing to disclose.
O76 | The acute effects of sleep restriction
therapy for insomnia on circadian timing: a
within-­subjects evaluation of phase angle
L.F. Maurer1; S. Ftouni1,2; C.A. Espie1; L. Bisdounis1; S.D.
Kyle1
1
NDCN, University of Oxford/Sleep & Circadian Neuroscience Institute;
2
Circadian Therapeutics, Oxford, United Kingdom
Objectives/Introduction: Sleep restriction therapy (SRT) has been
shown to improve insomnia symptoms by restricting sleep opportu-
nity. Curtailment of time in bed affects the duration and consolida-
tion of sleep, but also its timing. While recent work suggests that
the relationship between circadian and behavioural timing for sleep
may be abnormal in insomnia, no study has investigated if SRT modi-
fies this relationship. Here, we examined change in phase angle after
2 weeks of SRT.
Methods: Participants followed standard SRT guidelines for
2 weeks. Phase angle was derived from the difference between the
decimal clock time of dim light melatonin onset (DLMO) and aver-
age attempted sleep time of the previous 7 days at baseline and
post-­treatment. Secondary outcomes included sleep continuity, in-
somnia severity and repeated measures of vigilance that were as-
sessed in the laboratory at the same day as DLMO at baseline and
post-­treatment.
Results: Eighteen participants meeting insomnia criteria (mean
age = 37.06+8.99) were included in the analysis. In line with previous
research, results showed improvements in subjective and objective
sleep continuity variables (ps  < 0.001) and reductions in insomnia
severity (p < 0.001) following 2-­weeks of SRT. The primary outcome,
phase angle, was determined in 15 participants and revealed an
increase of 34.8 (+62.16) minutes from baseline to post-­treatment
(2.27+0.94 hr vs 2.85+1.25 hr; p = 0.048). While attempted sleep
was 46.8 (+40.2) minutes later (23:05 vs 23:52; p < 0.001), DLMO
stayed relatively stable (20:49 vs 21:01; p = 0.543). Consequently,
the time span between melatonin rise and attempted sleep was
increased from baseline to post-­treatment. Repeated measures of
 |
40 of 356       ABSTRACTS
reaction times, attentional lapses and subjective sleepiness indi-
cated significant deteriorations after 2 weeks of SRT (ps ≤ 0.042).
Conclusions: For the first time, this study has illustrated that SRT
increases phase angle in its acute phase by delaying the timing for
sleep attempt when DLMO stayed relatively stable. Future studies
are needed to experimentally test if an increase in phase angle is
linked to therapeutic benefits for insomnia.
Disclosure: This research study was supported by the National
Institute for Health Research (NIHR) Oxford Biomedical Research
Centre (BRC). The views expressed are those of the authors and
not necessarily those of the NHS, the NIHR or the Department of
Health. The research was also supported through a DPhil Scholarship
(to LFM) from the Dr Mortimer and Theresa Sackler foundation.
Financial disclosure statement: CAE is co-­
founder of and share-
holder in Big Health Ltd, a company which specialises in the digital
delivery of cognitive behavioural therapy for sleep improvement
(Sleepio). Non-­financial disclosure statement: SDK reports nonfinan-
cial support from Big Health Ltd. in the form of no-­cost access to
Sleepio for use in clinical trial research. All other investigators report
no competing interests.
O77 | Sleep restriction effects on object-­
location-­associative-­memory performance: a
randomized controlled sleep deprivation versus
multinap study in healthy elderly at low and high
genetic risk of Alzheimer's
A. Michalak1; V. Grove2; Z. Shabana1; C. Dietrich2; J.
Tsigarides2; N. Gill1; E. Mioshi1; A.M. Minihane2; M.
Hornberger2; A.S. Lazar1
1
School of Health Sciences, Faculty of Medicine and Health Sciences,
University of East Anglia, Norwich, United Kingdom; 2Norwich Medical
School, Faculty of Medicine and Health Sciences, University of East
Anglia, Norwich, United Kingdom
Objectives/Introduction: Episodic memory decline, disrupted sleep
and circadian rhythmicity are common hallmarks of neurodegenera-
tion. Even individuals at-­genetic-­risk of Alzheimer's (APOE-­ε4+ carri-
ers) show preclinical episodic memory and sleep deficits suggesting
that impaired sleep might be a harbinger for cognitive deficits and
the onset of dementia. Less is known as to how sleep-­wake homeo-
stasis and circadian system might interact in modulating the onset
of these cognitive deficits. The current study tries to disentangle
this by contrasting the effect of experimentally induced high versus
low sleep pressure conditions on episodic memory performance in
healthy elderly at low and high genetic risk of Alzheimer's.
Methods: Twenty-­
one healthy elderly participants (12 females,
age = 65+8; APOE-­ε4¯(low risk) n = 14; APOE-­ε4+(high risk) n = 7)
underwent a 2.5-­days-­long laboratory session in dim light condition
(<10 lx) and followed a modified constant routine protocol in the
Sleep and Brain Research Unit of University of East Anglia. After a
baseline night the participants were randomly assigned into either a
40-­h sleep deprivation or a multi-­nap experimental condition includ-
ing consecutive intervals of 160-­mins of wake and 80-­mins of sleep.
Episodic memory task was administered every 4 hours. Participants
were asked to encode 15 everyday objects (targets) and their loca-
tion on the screen. Right after the encoding phase, the targets were
intermixed with 15 distractors and the participants were asked to
perform old-­new-­recognition-­task followed by a screen-­location-­
recall-­judgment (source-­memory test). Stimuli sets were new for
each testing session to reduce re-­encoding effects.
Results: Multivariate linear analysis returned significant main ef-
fects of experimental condition for overall task-­
completion-­
time
(F = 19.82, p = 0.008), recognition-­false-­alarms (F = 8.77, p = 0.009),
recognition-­correct-­rejections (F = 6.26, p = 0.024) and a statistical
trend for source-­memory-­misses (F = 1.94, p = 0.049). Results indi-
cate lower performance during sleep deprivation across all partici-
pants. Finally, preliminary analyses returned a significant protocol x
genotype interaction (F = 6.10, p = 0.030) indicating a greater impact
of sleep deprivation on performance impairment among high-­risk
participants compared to controls. Group differences peaked during
the circadian night.
Conclusions: Our results confirm the negative impact of sleep dep-
rivation on episodic memory performance and uncover its interac-
tions with the time-­of-­the-­day. Our preliminary results also show
a greater cognitive vulnerability to sleep loss in healthy elderly at
increased genetic risk for Alzheimer's.
Disclosure: Nothing to disclose.
O78 | Ultradian light-­dark cycle: a circadian-­
time dependent influence on the distribution and
quality of sleep and waking
F. Fuchs1; L. Robin-Choteau1,2; L. Hugueny3; S. Doridot4; D.
Ciocca4; P. Bourgin1,3
1
Institut de Neurosciences Cellulaires et Intégratives – UPR3212 –
CNRS/Université de Strasbourg; 2Centre Européen d'Etude du Diabète;
3
CHRU Strasbourg – Centre des Troubles du Sommeil; 4Chronobiotron
– UMS3415 – CNRS/Université de Strasbourg, Strasbourg, France
Objectives/Introduction: Growing development of new light de-
vices lead us to be exposed to light at inappropriate times. Important
health consequences are already demonstrated, however the effects
of such exposures on physiology and behavior remains insufficiently
understood. The use of ultradian cycle in mice allows to study the
influence of repeated light exposures, according to circadian time,
on sleep and waking quality and distribution.
Methods: Electrocorticographic recordings were performed on 9
male C57BL/6 mice exposed to an ultradian 1 h-­light/1 h-­dark cycle
(named ‘T2 cycle’) during 24 h and compared to the classical 12 h-­
light/12 h-­dark cycle (‘T24 cycle’). Quantitative analyses explored
ABSTRACTS
circadian distribution of waking, slow wave sleep and REM sleep (du-
ration, fragmentation) and spectral analyses allowed us to evaluate
the impact of such an ultradian cycle on the homeostatic process
(delta power during slow wave sleep episodes) and alertness (delta,
beta and gamma power during waking episodes).
Results: During T2 cycle, light pulses induced sleep, especially during
early subjective night, that lead to a 30% reduction of sleep and wak-
ing circadian rhythms amplitude compared to T24 cycle. Moreover,
the reduction of total wake amount observed during subjective night
was accompanied by a critical fragmentation of episodes (40% re-
duction of wake amount due to episodes longer than 1 h). However,
in spite of this waking fragmentation, homeostatic process was con-
served, with a circadian evolution of delta power during slow wave
sleep similar between T2 and T24 cycles. Finally, dark pulses induced
an increase in EEG beta and gamma activities suggesting increased
level of alertness all 24 h-­long, whereas light pulses during subjective
night increased EEG delta activity and decreased EEG gamma power
suggesting reduced alertness.
Conclusions: Ultradian light-­dark cycle induces critical modifications
of sleep and waking distribution and quality (alertness), depending
on circadian time, but does not seem to influence the homeostatic
process. These observations are important to better understand the
consequences of inappropriate light exposures on physiology and
behavior, in order to adapt and optimize our societal lightning and
to improve the medical care of subjects exposed to irregular light
cycles.
Disclosure: Nothing to disclose.
H Y P O C R E TI N S/O R E X I N S A N D
C A R D I OVA S CU L A R D I S E A S E R I S K :
N A RCO LE P S Y T Y PE 1 A N D B E YO N D
O79 | Novel findings on cardiovascular and
autonomic alterations in paediatric patients with
narcolepsy type 1
F. Pizza1,2
1
Department of Biomedical and Neuromotor Sciences (DIBINEM),
University of Bologna; 2IRCCS Istituto delle Scienze Neurologiche di
Bologna, Bologna, Italy
Narcolepsy type 1 (NT1) has been associated with cardiovascular al-
terations in adults (such as a non dipper blood pressure profile) that,
together with the impact of long-­term pharmacological treatment
and the frequent comorbid obesity, may underlie an overall increase
in cardiovascular risk. Very few data are available on cardiovascu-
lar features in paediatric NT1, but they may help in understanding
the role of hypocretin neurotransmission defect given the temporal
proximity to disease onset.
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Recent studies addressed heart rate variability (HRV) and pulse
transit time (PTT) changes during nocturnal sleep in pediatric NT1 as
objective measures of autonomic dysfunction. NT1 patients showed
an increased power in the very low frequency and low frequency
ranges of HRV during non REM sleep stages 2 and 3, suggesting an
increase of sympathetic tone and an altered sympatho-­vagal balance.
Moreover, the increase of PTT during sleep (a marker of decreasing
blood pressure) was less pronounced in NT1 patients compared to
controls across overall nocturnal sleep and, especially, during REM
sleep. The blunted changes of PTT during sleep in NT1 were cor-
related with cerebrospinal hypocretin levels and obesity status.
Pediatric NT1 patients showed alterations of cardiovascular reg-
ulation during sleep that, albeit mild, may increase cardiovascular
risk along disease course. Clinicians should carefully consider cardio-
vascular features in the management of NT1 in patients of all ages.
Disclosure: Nothing to disclose.
O80 | Systemic inflammatory networks and
atherosclerosis burden in mouse models of sleep
fragmentation and narcolepsy type 1
C. McAlpine
Center for Systems Biology, Massachusetts General Hospital, Boston,
MA, United States
Sleep is integral to health. Although insufficient or disrupted sleep
increases the risk of multiple pathological conditions, including car-
diovascular disease, we know little about the cellular and molecular
mechanisms by which sleep maintains cardiovascular health. We
explore how sleep shapes systemic inflammatory networks and pro-
tects against atherosclerosis. In mice, sleep fragmentation promotes
a myeloproliferative phenotype that results in the overt generation of
Ly-­6C high monocytes and larger atherosclerotic lesions. This inflam-
matory profile is maintained by restricting hypocretin production in
the later hypothalamus during sleep fragmentation. Hypocretin con-
trols myelopoiesis by limiting the production of colony stimulating
factor (CSF)-­1 by hypocretin receptor-­expressing pre-­neutrophils in
the bone marrow microenvironment. Whereas hypocretin-­null and
haematopoietic hypocretin-­receptor-­null mice develop monocytosis
and accelerated atherosclerosis, sleep-­fragmented mice with either
haematopoietic CSF1 deficiency or hypocretin supplementation
have reduced numbers of circulating monocytes and smaller athero-
sclerotic lesions. Together, these findings identify a neuro-­immune
axis that links sleep to haematopoiesis and atherosclerosis.
Disclosure: Nothing to disclose.
 |
42 of 356       ABSTRACTS
CO NTR I B U TI O N S O F S LE E P TO DAY TI M E
FU N C TI O N I N G , W E LL- ­B E I N G A N D
CO G N ITI V E FATI G U E
O81 | How does cognitive fatigue affect young,
middle-­aged, and older people at the behavioral
and brain level?
F. Collette; J. Gilsoul
GIGA-­CRC, University of Liège, Liège, Belgium
Young people classically experiment cognitive fatigue after long-­
lasting cognitive tasks (Time-on-Task effect), as evidenced by changes
in response time (RT) distribution (Wang et al., 2014) and brain ac-
tivity (Qi et al., 2019). However, very few data exists on cognitive
fatigue in middle-­aged and older people. In a first study, we explored
the Time-­
on-­
Task effect from young to older ages. Twenty-­
one
Young, 17 Middle-­aged, and 17 Older performed a 160-­min Stroop
task divided into four 40 min blocks. Using ex-­Gaussian parameters
analyses, we observed that the middle-­aged group was the most
sensitive to Time-­on-­Task, and more particularly in their decisional
processes as indexed by increases in their extreme RT (ex-­Gaussian
Tau parameter). In a second study, we administered to these three
age groups (47 Young, 41 Middle-­aged and 40 Older participants)
an N-­Back task (1, 2 and 3-­back load) in an fMRI scanner in con-
dition of fatigue (Stroop task during 80 to 100 minutes) or rest
(watching videos during the same time). Brain imaging data were
analyzed with SPM12 (p < 0.05 FWE and p < 0.001 uncorrected).
Beside the expected effect of group and task load, we observed that
the fatigue condition was associated with increased activity in the
fronto-­parietal network classically recruited by the n-­back task. We
did not observe a Group X Condition interaction on accuracy level
(d’) but middle-­aged people used more liberal decision criteria in the
fatigue condition. At the brain level, the recruitment of parietal and
frontal areas differed between young and middle-­aged participants
in the fatigue condition by comparison to rest. This effect was not
observed in older. Again, these results suggest larger fatigue effect
in middle-­aged. In conclusion, our studies indicate that the effect
of fatigue on cognition and brain activity differs according to age,
with middle-­aged people being the most sensitive to fatigue effect.
We suggest this finding could be due to a suboptimal cognitive state
in that group triggered by a high level of chronic stress due to the
numerous familial and professional activities they are involved in.
Disclosure: Nothing to disclose.
O82 | Local slow-­wave activity and its relation
to mind-­wandering
F. Van Opstal
Department of Psychology, Brain & Cognition, University of
Amsterdam, Amsterdam, The Netherlands
Mind-­wandering (MW), or having thoughts that are unrelated or ir-
relevant for the task at hand, is known to be highly prevalent in daily
life (from 20% to 50% of our time awake). This pervasiveness of MW
episodes is not without risk and there is mounting evidence of its
negative consequences on behavior. The nature of this detrimental
behavior, however, remains unknown. Here, I will present some re-
cent behavioral results showing that the frequency of MW episodes
relates to the use of very specific brain networks related to the task
at hand. To further test the hypothesis that the use of task-­related
related networks were related to an increase in sleep pressure, an
EEG experiment was performed to relate task performance to local
changes in sleep-­
like brain activity (i.e., increases in local theta
power). Together, these results propose that some instances of MW
might be caused to use-­dependent increases in local sleep pressure.
Disclosure: Nothing to disclose.
O83 | The impact of noise on sleep and cardio-­
metabolic markers
L. Thiesse1,2; F. Rudzik1; J.M. Wunderli3; M. Brink4; N.
Probst-Hensch5; M. Röösli5; C. Cajochen1
1
Centre for Chronobiology, Psychiatric Hospital of the University of
Basel (UPK), Transfaculty Research Platform Molecular and Cognitive
Neurosciences (MCN), University of Basel, Basel, Switzerland; 2PPRS
Research, Colmar, France; 3Empa – Laboratory for Acoustics/
Noise Control, Swiss Federal Laboratories for Materials Science and
Technology, Dübendorf; 4Federal Office for the Environment, Bern;
5
Swiss Tropical and Public Health Institute, Basel, Switzerland
Noise is one of the most important environmental risk factors for
cardio-­metabolic diseases. It is assumed that short-­term noise ex-
posure activates a physiological stress response, which in a chronic
state can cascade to long-­term critical health problems. Sleep dis-
turbances are regarded as the main mediator of transportation noise
induced cardio-­metabolic diseases. However, no study so far investi-
gated short-­term effects of nocturnal transportation noise exposure
on glucose regulation and stress markers in association with altera-
tions in sleep macro-­and microstructure.
Twenty-­six young (19–33 y) and 16 older (52–70 y) volunteers
participated in a 6-­day controlled laboratory study. The experiment
started and ended respectively with a noise-­free baseline and re-
covery night; in-­between four different transportation noise sce-
narios (low/medium/high intermittent road or rail scenarios with an
ABSTRACTS
identical equivalent continuous sound level of 45 dB) were presented
in a randomized order to the volunteers. During the all experiment,
sleep and cardiac activity were recorded with polysomnography
and nocturnal catecholamine and daytime cortisol were assessed.
Glucose tolerance and inflammatory markers were assessed in the
morning of the baseline, the last noise night and the recovery night.
Sleep macrostructure and the number of cortical arousals were
not significantly altered by nocturnal transportation noise exposure.
However, cumulative autonomic arousals duration increased during
the highly intermittent road noise scenario night for the young group
and during the highly intermittent railway noise scenario night for
the entire experimental group compared to baseline night. Noise ex-
posure reduced glucose tolerance, a reduction associated with the
increase in cumulative autonomic arousals duration. Highly intermit-
tent road noise increased next evening cortisol levels in the young
subgroup. This increase was associated with the increase in cumula-
tive autonomic arousal duration during the previous sleep episode.
Nocturnal blood pressure, HRV spectral analysis and catecholamine
as well as morning inflammatory markers were not significantly
changed by the noise exposure.
Taken together, even if the effect observed on glucose regula-
tion was not clinically significant, these results underline the harmful
effect of nocturnal transportation noise on subcortical activation
during sleep and its repercussions on daytime stress and metabolic
system. In a chronic state these effects may lead on long-­term to
cardio-­metabolic diseases.
Disclosure: Nothing to disclose.
K E Y N OTE LEC T U R E – R . B E N C A , U S
O84 | La vida es sueño: sleep and psychiatry
R. Benca
Psychiatry and Human Behavior, University of California, Irvine, Irvine,
CA, United States
Sleep and dreaming have been a consistent focus in the field of mod-
ern psychiatry, beginning with Freud and Jung, who felt that explo-
ration of dream content could be useful in clinical treatment. After
the discovery of REM sleep by Aserinsky and Kleitman, the field of
psychiatry shifted towards attempting to understand the neurobio-
logical basis of sleep and its role in waking thoughts and behaviors.
A large number of studies focused on describing relationships be-
tween sleep architecture and psychiatric disorders, in an attempt to
find some objective markers for disorders that have continued to be
diagnosed exclusively by their clinical symptoms. While sleep archi-
tecture changes yielded minimal diagnostic utility, they did provide
insights into neurobiological abnormalities in psychiatric patients. As
we have applied new methods to study sleep and have learned more
about normal sleep function, it has become clear that we can learn
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much about psychiatric illness from the sleeping brain. Local changes
in sleeping brain activity, as well as disruptions in circadian rhythms
of sleep-­wake behavior, are present in many major psychiatric ill-
nesses, and some may provide diagnostic and prognostic specific-
ity. Sleep patterns are closely linked to brain maturation and predict
increased risk for psychiatric disorders. As we age, sleep problems
increase risk for cognitive impairment and neurodegenerative dis-
orders. While life may not be a dream, the sleeping brain can teach
us much about mental illness and perhaps can provide therapeutic
targets to prevent or mitigate the effects of psychiatric disorders.
Disclosure: Dr. Benca has served as a consultant to Eisai, Genomind,
Jazz, Merck, and Sunovion.
T W E A K I N G TH E ‘ S PEC TR A L D I E T ’:
O P TI M I S I N G LI G HT E X P OS U R E FO R
B E T TE R S LE E P
O85 | Effects of pre-­sleep artificial light
exposure on fundamental cognitive processes
C. Blume1,2
1
Centre for Chronobiology Centre for Chronobiology, Psychiatric
Hospital of the University of Basel (UPK), Transfaculty Research
Platform Molecular and Cognitive Neurosciences (MCN), University
of Basel; 2Transfaculty Research Platform Molecular and Cognitive
Neurosciences, University of Basel, Basel, Switzerland
Introduction: Pre-­sleep artificial light is known to increase alertness
and negatively affect sleep, particularly when peaking in the short
(‘blue’) wavelength range. However, we do not know whether artifi-
cial light also alters fundamental cognitive processes.
Objectives: In a recent study, we therefore sought to investigate the
acute (wake) and delayed (sleep) effects of pre-­sleep light exposure
(LE) on predictive coding, a basic principle of sensory processing.
Specifically, we studied whether and how LE modulates automatic
short-­term (‘local’) responses to auditory input and responses to
long-­term (‘global’, contingent upon attention) (ir-­)regularities.
Methods: We investigated how 1-­h exposure to two metameric light
sources starting 1h50min prior to an 8-­h sleep episode, affects pre-
dictive coding. Light conditions differ in their effect on melanopsin-­
expressing retinal ganglion cells (mel-­high vs. mel-­low, contrast 2.14,
≈59 lux). Thirty healthy participants (18–30 years) underwent a hier-
archical auditory stimulation paradigm during both light conditions.
Cognitive processing was evaluated using event-­related potentials
(ERPs). Additionally, we assessed melatonin levels, subjective sleepi-
ness, behavioural alertness, and sleep quality.
Results: Due to COVID-­19, analyses are still preliminary or pending.
Preliminary of ERP data (N = 9) indicate that, during wakefulness, the
(automatic) detection of local irregularities gives rise to a mismatch
negativity (MMN). The detection of global irregularities is associated
 |
44 of 356       ABSTRACTS
with a P300 response. There are no differences between mel-­high
and mel-­low LE. Generally, we find an acutely alerting effect of light
(N = 19). Additionally, results suggest that participants were more
alert in the mornings following mel-­low light and sleep was less frag-
mented. Melatonin and sleep-­EEG data analyses are pending.
Discussion: Thus far, preliminary results suggest that high-­melanopic
light does not have an acute differential effect on predictive coding
during wakefulness. Generally, and irrespective of the light source,
LE has an acutely alerting effect. Moreover, participants are more
alert in the mornings following low-­melanopic LE. Surprisingly, we
do not find evidence for a specific alerting effect of high-­mel LE,
an otherwise seemingly well-­established finding. Pending melatonin
analyses are required for a valid interpretation of these findings.
Disclosure: Nothing to disclose.
O86 | Mathematical modelling of light,
sleep and circadian rhythmicity applied to
schizophrenia
A.C. Skeldon1,2; N. Meyer3; K. Wulff4,5; D.-J. Dijk 2,6
1 O87 | Microsleep episodes in the vigilance
Mathematics, University of Surrey, Guildford; 2UK Dementia
Research Institute – Care Research & Technology, University of
Surrey; 3Psychosis Studies, Institute of Psychiatry, Psychology and
Neuroscience, King's College London, London, United Kingdom;
4 5
Molecular Biology, Umea Universitet; Wallenberg Centre for
6
Molecular Medicine, Umea, Sweden; Surrey Sleep Research Centre,
University of Surrey, Guildford, United Kingdom
Well-­established models exist that describe the way light deter-
mines circadian phase. These models were originally designed to fit
laboratory studies that measured the phase response to different
light exposure protocols. Such models have since been used to non-­
invasively determine circadian phase from field-­collected light data.
The fundamental processes underlying sleep regulation are also
well-­known, consisting of the two core principles that sleep depends
on time awake (sleep homeostasis) and time-­of-­day (circadian rhyth-
micity). These principles are enshrined in the two-­process model of
sleep-­wake regulation and underpin more recent neuronal models
that describe sleep and wake as a flipping between the firing of sleep
promoting and wake promoting neurons.
Recent models have combined both sleep regulation and models
of light to describe chronotype, internal desynchrony, sleep timing
in hunter-­gatherers versus humans living in industrialised societies,
quantitative changes in sleep duration and timing across the lifes-
pan. Including social constraints, also enables such models to de-
scribe forced desynchrony protocols, shift work, social jetlag and the
possible impact of societal changes (e.g. daylight saving time). An im-
portant feature of these models is that they include self-­selection of
light. Specifically, with access to electric light we can choose to have
light on after dusk so that light is gated by when we sleep and not
by the environmental zeitgebers of dusk and dawn. The consequent
feedback from the timing of sleep on light input to the circadian
clock is critical in determining circadian timing and chronotype.
Here, we describe the key elements of the mathematical models
and how they can be applied. In particular, we consider two inde-
pendent studies of those living with schizophrenia. In both studies
there are individuals who show non–24 h rhythms. Using a mathe-
matical model, we show that low levels of light exposure with little
differentiation between night and day is a parsimonious explanation
for these non–24 h rhythms. In addition, the model suggests that for
the two individuals who show seasonal changes in synchrony, these
seasonal changes may be explained by seasonal changes in light ex-
posure. Further, we then use the model to suggest appropriate light
interventions to stabilise 24 h rhythmicity.
Disclosure: Nothing to disclose.
TH E B O R D E R L A N D B E T W E E N
WA K E FU LN E S S A N D S LE E P
assessment
D. Schreier
Department of Neurology, Inselspital, Bern, Switzerland
The scientific sleep-­wake model was traditionally regarded as a bi-
nary model, except for the subdivision of sleep, reflecting a global
stage of the brain changing over time. Particularly in the last two
decades, the model has evolved and become more complex. We now
know that both wakefulness and sleep can occur on a local level and,
therefore, even co-­exist. This dissociation is not only limited to corti-
cal structures but also valid for subcortical structures. Hence, some
cortical structures might be awake while other cortical or subcortical
structures sleep, and vice-­versa. Since changes between different
stages can also occur very rapidly, higher spatial and temporal reso-
lutions are required for more precise analyses. Despite the scientific
advances, the clinical scoring and analysis of wakefulness and sleep
has barely changed since the last century, neglecting both local and
temporal aspects. It can be speculated that the effort required to
conduct such analyses was disproportionately high compared to the
new information obtained. The recent rapid development of artifi-
cial intelligence, i.e. machine learning, could compensate for those
expenditures and lead not only to new scientific insights but also
facilitate the translation from research to clinical routine.
A great proportion of sleep-­
wake disorders result in exces-
sive daytime sleepiness, which is also increasingly prevalent in the
general population. Sleepiness is a very complex construct and its
quantification is still challenging. Integrating sleepiness into the
sleep-­
wake model, sleepiness is represented by the borderland
between wakefulness and sleep. The clinical neurophysiological
ABSTRACTS
correlative includes microsleep episodes. The definition of micros-
leep episodes is mainly related to the assessment method (electro-
encephalography, behaviour, and performance), and a combination
of assessments might result in a more sophisticated definition and
improved detection. The systematic investigation and analysis of
microsleep episodes can lead to a better understanding of the un-
derlying processes and could be of diagnostic and prognostic value.
However, to which extent sleepiness can be quantified by the char-
acteristics of microsleep episodes, i.e. as a biomarker, is still unclear
and needs to be further investigated.
Disclosure: Nothing to disclose.
O88 | Redefining CNS hypersomnolence
disorders
R. Fronczek1,2
1
Department of Neurology, Leiden University Medical Centre,
Leiden; 2Sleep-­Wake Centre Stichting Epilepsie Instelling Nederland,
Heemstede, The Netherlands
Central disorders of hypersomnolence are characterized by exces-
sive daytime sleepiness despite normal timing of nocturnal sleep.
This presentation will cover neuroscience and neuroimaging findings
in these disorders: narcolepsy type 1 & 2 (NT1 & NT 2) and idiopathic
hypersomnia (IH).
While NT1 originates from a selective loss of hypothalamic
hypocretin-­producing neurons, the pathophysiology underlying NT2
and IH remains to be fully elucidated. It is probable that different
causes may lead to these phenotypes. All are diagnosed according
to the current International Classification of Sleep Disorders – third
edition (ICSD-­3). This classification distinguishes NT2 and IH based
upon one neurophysiological test: The Multiple Sleep Latency Test
(MSLT). Clinically, the distinction between NT2 and IH is not clear.
Furthermore, the current classification makes no distinction be-
tween IH with a short versus a long sleep time. The current classifi-
cation might actually reflect the pathophysiology of distinct disease
entities or might arbitrarily split a heterogeneous group of patients.
More understanding of the psychophysiology of these disorders is
thus very much needed.
This presentation will cover neurobiological and neuroimaging
findings, which can help to improve classification and can shed light
on the neural mechanisms involved in the regulation of sleep, vigi-
lance and alertness.
Disclosure: Conference travel support and lectures: Bioprojet.
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O R A L 10 – S LE E P D I S O R D E R E D
B R E ATH I N G : CO M O R B I D ITI E S A N D
S Y M P TO M S
O89 | Pitolisant evaluation in obstructive
sleep apnea patients treated by nasal continuous
positive airway pressure but still complaining of
excessive daytime sleepiness
J.-L. Pépin1; J. Verbraecken2; V. Attali3; D. Dokic4; B. Buyse5;
M. Partinen6; T. Saaresranta7; I. Fietze8; O. Georgiev9; G.
Belev10; R. Tamisier11; I. Lecomte12; J.-M. Lecomte13; P.
Levy14; J.-C. Schwartz15; Y. Dauvilliers16
1
Grenoble University Hospital, ADTSAS, Grenoble, France; 2Slaap
Centrum, Universtiair Multidisciplinair Slaap Centrum, Edegem-­
Antwerp, Belgium; 3Sorbonne Université, INSERM, UMRS1158
Neurophysiologie Respiratoire Expérimentale et Clinique, Paris;
AP-­HP, Groupe Hospitalier Universitaire APHP-­Sorbonne Université,
Pitié-­Salpêtrière, Service des Pathologies du Sommeil (Département
R3S), Paris, France; 4Department of Pulmonology and Allergy,
‘Mother Teresa’, Medical University, Skopje, North Macedonia;
5
Slaapcentrum, UZ Leuven/Campus Gasthuisberg, Leuven, Belgium;
6
Helsinki Sleep Clinic Vitalmed Research Centre, Helsinki; 7Sleep
Research Unit Lemminkäisenkatu, University of Turku, Turku,
Finland; 8Interdisziplinäres Schlafmedizinisches Zentrum, Charité –
Universitätsmedizin Berlin, Berlin, Germany; 9Department of Internal
Medicine, Pulmonology, Alexandrovska Hospital Medical University,
10
Sofia; Department of Internal Medicine, Pulmonology, St. George
11
Hospital Medical University, Plodiv, Bulgaria; Laboratoire EFCR et
12
Sommeil, University Hospital Thorax et Vaisseaux, Grenoble; Clinical
13 14
Development Department; Bioprojet Pharma, Paris; Pôle Thorax et
Vaisseaux Physiologie Sommeil et Exercice, CHU Michallon, Grenoble;
15 16
Bioprojet Biotech, Saint Grégoire; Neurologie Trouble du Sommeil
et de l’Éveil, Montpellier University Hospital, Montpellier, France
Objectives/Introduction: Residual Excessive Daytime Sleepiness
(rEDS) occurs in up to 12% of Obstructive Sleep Apnea (OSA) pa-
tients despite optimal continuous positive airway pressure (CPAP)
therapy. This study assessed the efficacy and safety of pitolisant, a
selective histamine H3-­receptor antagonist waking agent in moder-
ate to severe OSA treated by CPAP but exhibiting rEDS.
Methods: In a multicentre, double-­
blind, randomized, placebo-­
controlled trial, Pitolisant was individually titrated up to 20 mg/day
over 12 weeks. Primary endpoint was the Epworth Sleepiness Scale
(ESS) score change in intention to treat. Key secondary endpoints
were maintenance of wakefulness (Oxford Sleep Resistance Test
(OSleR)), clinical global impressions of severity (CGI), patient's global
opinion (PGO) and safety.
Results: 244 OSA patients (mean age: 53.1 years, mean
Apnoea+hypopnea index under CPAP: 4.18/hour, baseline ESS score:
14.7 (±2.9)) were randomized to Pitolisant (n = 183) and placebo (pl)
 |
46 of 356       ABSTRACTS
(n = 61). ESS was significantly reduced with Pitolisant compared to pl
−2.6 (95% CI: [−3.9; −1.4]) (p < 0.001). The ratio of increase in mean
latency during OSleR Tests significantly improved with Pitolisant vs
pl (1·44 vs 1.22, p = 0.05). The overall impact of Pitolisant was con-
firmed by physicians (CGI-­C) and patients (PGO). Adverse event in-
cidence was higher with Pitolisant vs pl (47.0% and 32.8%, p = 0.03),
the difference was mainly due to a higher proportion of headache,
and insomnia. No cardiovascular or other significant safety concerns
were reported.
Conclusions: Pitolisant as add-­on to CPAP therapy for rEDS in OSA
patients significantly reduced EDS and improved both patient and
physician disease severity assessment.
Disclosure: The study was sponsored by bioprojet pharma. J. L.
Pépin, J. Verbraecken, V. Attali, D. Dokic, B. Buyse, M. Partinen, T.
Saaresranta, I. Fietze, O. Georgiev, G. Belev, R. Tamisier, P. Levy, Y.
Dauvilliers: clinical investigators of the study. I. Lecomte: employee
of bioprojet pharma J. M. Lecomte, J. C. Schwartz: founder of bio-
projet pharma.
O90 | Effects of solriamfetol on driving
performance in participants with excessive
daytime sleepiness associated with obstructive
sleep apnoea
F. Vinckenbosch1; J. Asin2; N. de Vries3; P. Vonk3; C.
Donjacour4; G.J. Lammers4; S. Overeem5,6; H. Janssen5; G.
Wang7; D. Chen7; L. Carter7; K. Zhou7; A. Vermeeren1; J.
Ramaekers1
1
Maastricht University, Maastricht; 2Center for Sleep Medicine
Amphia, Breda; 3OLVG, Amsterdam; 4Sleep-­Wake Centre SEIN,
Leiden; 5Kempenhaeghe, Heeze; 6Eindhoven University of Technology,
Eindhoven, The Netherlands; 7Jazz Pharmaceuticals, Palo Alto, CA,
United States
Objectives/Introduction: Excessive daytime sleepiness (EDS) in
patients with obstructive sleep apnoea (OSA) is associated with an
increased risk of driving accidents. Solriamfetol, a dopamine/norepi-
nephrine reuptake inhibitor, is approved in the EU and US to improve
wakefulness and reduce EDS in adults with OSA who use or have
attempted to use therapy to treat the underlying airway obstruction
(approved dose range, 37.5–150 mg/day). This study evaluated the
effects of solriamfetol on on-­road driving performance in partici-
pants with EDS associated with OSA.
Methods: In each period of this randomised, double-­
blind,
placebo-­
controlled, crossover study (NCT02806895/EudraCT
2015-­0 03930-­28), driving performance during an on-­road driving
test was assessed at 2 and 6 hours post-­dose following 7 days of
treatment with solriamfetol (150 mg/day × 3 days, then 300 mg/
day × 4 days) or placebo. The primary endpoint—standard deviation
of lateral position (SDLP), a measure of ‘weaving’ (departure from a
steady lane position), at 2 hours post-­dose—was compared between
solriamfetol and placebo using a repeated mixed-­effects analysis of
variance model.
Results: The study included 34 participants. Baseline characteris-
tics reflected the broader OSA population (88% male; mean age,
52 years; mean Epworth Sleepiness Scale score, 14.4; Maintenance
of Wakefulness Test mean sleep latency, 14.3 minutes). SDLP at
2 hours post-­
dose was significantly lower following solriamfetol
(least squares [LS] mean [standard error; SE], 18.83 cm [0.63]) com-
pared with placebo (19.92 cm [0.63]): LS mean difference, −1.08 cm;
95% confidence interval (CI), −1.85, −0.32; p = 0.0062, indicating
better performance with solriamfetol; 1 participant receiving solri-
amfetol and 4 receiving placebo failed to complete the driving test
at this time point. At 6 hours post-­dose, SDLP following solriamfe-
tol (LS mean [SE], 19.24 cm [0.63]) was significantly lower compared
with placebo (20.04 cm [0.63]): LS mean difference, −0.80 cm; 95%
CI, −1.58, −0.03; p = 0.0432; 3 participants receiving solriamfetol
and 7 receiving placebo failed to complete the driving test at this
time point. Common adverse events (≥5%) with solriamfetol were
headache, nausea, insomnia, dizziness, and agitation.
Conclusions: Solriamfetol (300 mg/day) improved SDLP, an impor-
tant measure of driving performance, at 2 and 6 hours in participants
with EDS associated with OSA.
Disclosure: F Vinckenbosch is an employee of Maastricht University.
Maastricht University received financial support to conduct the pre-
sent study. J Asin has received consultancy fees and/or honoraria
and has been an advisory board participant for Bioprojet and Jazz
Pharmaceuticals. He has received several grants for research pro-
jects unrelated to this work from Philips, ResMed, and SomnoMed.
N de Vries has been an advisory board participant for NightBalance,
a study investigator for Inspire, and a consultant for the AE Mann
Foundation, Olympus, and Philips. PE Vonk has nothing to disclose.
CEHM Donjacour has received a research grant from UCB Pharma,
and served as a paid speaker for UCB Pharma and Eisai. GJ Lammers
has received consultancy fees and/or honoraria and has been a
speakers’ bureau member and/or an advisory board participant for
UCB Pharma, Bioprojet, Theranexus, and Jazz Pharmaceuticals.
S Overeem has received an unrestricted grant from UCB Pharma
for research unrelated to this work. H Janssen has nothing to dis-
close. G Wang, D Chen, L Carter, and K Zhou are employees of
Jazz Pharmaceuticals who, in the course of their employment, have
received stock options exercisable for, and other stock awards of,
ordinary shares of Jazz Pharmaceuticals plc. A Vermeeren is an
employee of Maastricht University. Maastricht University received
financial support to conduct the present study. JG Ramaekers has
received grants from pharmaceutical industries as well as national
(NWO, ZonMw) and international (EU Commission) funding bodies
that are unrelated to this work.
ABSTRACTS
O91 | The effect of armodafinil on sleep
spindles in obstructive sleep apnea: secondary
analyses of a randomised placebo-­controlled trial
L. Emami1; N.S. Marshall1; J.L. Chapman2,3; G. Cho1; R.R.
Grunstein1,4; B.J. Yee1,4; A.L. D'Rozario1,5
1
CIRUS, Centre for Sleep and Chronobiology, Woolcock Institute of
2
Medical Research, University of Sydney; Woolcock Institute of Medical
3
Research; Brain and Mind Sleep Team, University of Sydney, Sydney;
4
Royal Prince Alfred Hospital, Camperdown; 5School of Psychology,
Faculty of Science, Brain and Mind Centre and Charles Perkins Centre,
The University of Sydney, Sydney, NSW, Australia
Objectives/Introduction: Armodafinil has been trialled in OSA pa-
tients to promote wakefulness and simulated driving performance.
We have previously completed a 6-­month trial of 150 mg of ar-
modafinil vs placebo in moderate-­severe OSA patients not using
CPAP (ACTRN# 12611000847910) observing that participants on
armodafinil learnt to perform better across a 90-­
minute driving
simulator task faster than those on placebo. It is possible that this re-
duction in time-­on-­t ask decrement may have been due to increased
learning on armodafinil.
Sleep spindles have previously been implicated in procedural learn-
ing and neurobehavioral performance. We hypothesized that ar-
modafinil increases sleep spindle events during NREM sleep to
enhance learning.
Methods: Sixty three overweight severe OSA patients (mean BMI:
32.3 kg/m2 (26.1–42.5); age 53.1 years (28–71), 52 males) under-
went overnight in-­lab polysomnography at baseline (0 month) and
at a 6 month follow-­up. All-­night EEG signals were analysed using a
previously validated automated spindle detection algorithm. EEG re-
cordings were visually inspected by an experienced sleep physician
(LE), who was blinded to drug allocation. To minimise the likelihood
of type 1 error, we selected three key spindle variables detected at
Cz for analysis of change between 0 and 6 months: 1) total number
of spindle events (11–16 Hz) in NREM sleep 2) density of slow spin-
dles (≥11 to ≤13 Hz) per minute of NREM sleep, and 3) fast spindle
density in NREM (>13 to ≤16 Hz).
Results: The change in total spindle count in NREM sleep (ar-
modafinil = 11.6 vs Placebo = −17.1, p = 0.57), fast spindle density
(armodafinil = 0.06 vs Placebo = −0.02, p = 0.63) and slow spindle
density (armodafinil = −0.00 vs. Placebo = −0.03, p =0.74) were not
increased by armodafinil.
Conclusions: If armodafinil enhances simulated driving performance
in a way that suppresses time-­on-­t ask effects it does not appear to
be through a sleep spindle enhancing mechanism. Armodafinil is
probably not a pharmacological method of enhancing sleep spindles.
Disclosure: Nothing to disclose.
|
      47 of 356
O92 | Obstructive sleep apnea impacts on
hallmarks of cellular and molecular aging
L.S. Gaspar1,2,3; B. Santos1,2; C. Carvalhas-Almeida1,2;
A.T. Barros-Viegas1,2,4; S. Carmo-Silva1,2,4; F. Teixeira5; M.
Ferreira5; J. Moita5; C. Cavadas1,2,6; A.R. Álvaro1,2,4
1
Centre for Neuroscience and Cell Biology (CNC), University of Coimbra;
2
Center for Innovation in Biomedicine and Biotechnology (CIBB),
University of Coimbra; 3PDBEB – Doctoral Programme in Experimental
Biology and Biomedicine, Institute for Interdisciplinary Research (IIIUC),
University of Coimbra; 4Institute for Interdisciplinary Research (IIIUC),
University of Coimbra; 5Sleep Medicine Centre, Coimbra Hospital and
University Centre (CHUC); 6Institute for Interdisciplinary Research
(IIIUC), Faculty of Pharmacy (FFUC), University of Coimbra, Coimbra,
Portugal
Objectives/Introduction: Obstructive Sleep Apnea (OSA) is a high
prevalent sleep disorder worldwide but it is still vastly undiagnosed.
Untreated, OSA has been associated with a spectrum of several
chronic comorbidities, resembling what typically occurs along the
aging process. However, untreated OSA patients seem to exhibit
aging-­related alterations at younger ages. We propose that OSA
might aggravate/promote aging by inducing cellular and molecular
aging mechanisms. Understanding OSA effect on aging and aging-­
related diseases may not only guide into new strategies to improve
OSA diagnosis and treatment but also to counteract aging, a global
concern.
Methods: A cohort of 25 OSA male patients [age: 55 ± 2 years; body
mass index (BMI): 31 ± 4; apnea-­hypopnea index (AHI): 48 ± 5] was
followed from the moment of their diagnosis (polysomnography),
up to 4 months and 2 years of treatment with continuous posi-
tive airway pressure (CPAP). In each phase, blood was collected at
4 time points along day. Genomic instability, cellular senescence,
loss of proteostasis and impairments in intercellular communica-
tion were evaluated. Results were compared to age-­matched (age:
50 ± 4 years; BMI: 28 ± 3; AHI: 5 ± 1) and younger (age: 25 ± 1 years;
BMI: 23 ± 1) healthy subjects. This study was approved by CHUC
ethical committee.
Results: OSA patients’ blood samples show increased levels of DNA-­
damage response kinases (p < 0.01), a decreased cellular prolifera-
tion trend (p = 0.057) without evidences of increased cellular death,
and alterations in mRNA levels of key autophagy players (p < 0.01),
in comparison with age-­matched controls, an effect that is no longer
observed after treatment. In addition, intercellular communication
seem to be compromised as evidenced by disruptions in mRNA/
protein levels and profile of biological clocks’ regulators and outputs
(0.05 < p < 0.0001), hormones’ levels (p < 0.05), and extracellular
vesicles release (p < 0.01), alterations that are not completely re-
verted upon OSA treatment.
Conclusions: Our results show that OSA aggravates/promotes
hallmarks of cellular and molecular aging, some of which are not
 |
48 of 356       ABSTRACTS
reverted upon CPAP treatment. This data reinforces the urgent need
of new approaches on OSA diagnosis and treatment.
Funding: POCI- ­01- ­0145-­FEDER- ­029002, PD/BD/135497/2018,
UIDB/04539/2020.
Disclosure: Nothing to disclose.
O93 | Chronic thromboembolic pulmonary
hypertension: improvement of sleep-­disordered
breathing after balloon pulmonary angioplasty
K. Hackner1,2; M. Maurer2; C. Gerges2; M. Gerges2; M.
Kneussl3; P. Errhalt1; S. Javaheri4; I. Lang2
1
Department of Pneumology, Karl Landsteiner University of Health
Sciences, Krems; 2Department of Internal Medicine II, Division of
Cardiology, Medical University of Vienna; 3Department of Internal
Medicine II and Pneumology, Wilhelminenspital, Vienna, Austria;
4
Division of Pulmonary and Sleep Medicine, Bethesda North Hospital,
Cincinnati, OH, United States
Objectives/Introduction: Chronic thromboembolic pulmonary hy-
pertension (CTEPH) is characterized by severe pulmonary artery
hypertension and presence of sleep-­
disordered breathing (SDB)
with associated hypoxemia could further contribute to the severity
of hypertension adversely affecting the outcome. Limited data are
available on the prevalence of SDB in CTEPH, and so far, the ef-
fect of balloon pulmonary angioplasty (BPA) on SDB has not been
evaluated. We hypothesized that subjects with CTEPH have a high
prevalence of SDB, both obstructive and central sleep apnea (CSA)
with associated hypoxemia, which could improve with BPA.
Methods: 31 consecutive patients with CTEPH underwent
treatment-­naïve and post-­BPA polygraphy (nasal pressure sensor,
thermistor, sensors for thoracoabdominal excursions, and a pulse
oximeter; Alice PDx, Philipps®) and hemodynamic and echocardio-
graphic assessments.
Results: Before BPA, prevalence of SDB (defined as an apnea-­
hypopnea index (AHI) >5 per hour was 75%: 8 patients (24%) with-
out SDB, 18 (54%) with predominantly obstructive sleep apnea
(OSA; AHI = 26), and 7 (21%) with predominantly central sleep apnea
(CSA; AHI = 41). OSA was associated with male gender, obesity,
and overnight fluid-­shifts, whereas CSA was associated with worse
right ventricular end-­diastolic diameter. Patients with SDB had sig-
nificantly higher oxygen-­
desaturation index (ODI), and tendency
for worse desaturation than those without SDB. After BPA, mean
AHI and ODI decreased by 45% (p = 0.004) and 28% (p = 0.001), re-
spectively. In OSA patients, AHI decreased from 26 to 19 (p = 0.088)
and in CSA patients AHI decreased from 41 to 21 (p = 0.011). Along
with improvement in SDB, nocturnal desaturation decreased (time-­
below-­90% from 50% to 43% of time-­in-­bed, p = 0.037).
Conclusions: This is the first study of the effects of BPA on SDB in
CTEPH. We found a high prevalence of SDB, both OSA and CSA,
in consecutive subjects underdoing BPA, and report that BPA
significantly improved sleep-­
disordered breathing and nocturnal
desaturations. Future randomized controlled trials are needed to de-
termine if effective treatment of SDB improves central hemodynam-
ics, morbidity and mortality of patients with CTEPH.
Disclosure: Nothing to disclose.
O94 | A network-­based analysis of the
association between comorbidities in patients
with obstructive sleep apnea using the ESADA
network database
C. Nikolaidis1; S. Bailly2; S. Mihaicuta3; L. Grote 4; W.T.
McNicholas5; J. Verbraecken6; I. Bouloukaki7; S. Ryan5;
O.K. Basoglu8; C. Lombardi9; A. Pataka10; O. Marrone11;
G. Trakada12; S.E. Schiza7; J.-L. Pepin2; J. Hedner4; M.R.
Bonsignore13; P. Steiropoulos1; ESADA Study Group
1
Sleep Unit, Department of Pneumonology, Medical School, Democritus
University of Thrace, Alexandroupolis, Greece; 2University Grenoble
Alpes, INSERM HP2 (U1042), Grenoble, France; 3Department of
Pulmonology, Victor Babeş’ University of Medicine and Pharmacy
Timişoara, Timişoara, Romania; 4Department of Sleep Medicine,
Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden;
5
Department of Respiratory and Sleep Medicine, St. Vincent's
University Hospital, School of Medicine, University College, Dublin,
Ireland; 6Faculty of Medicine and Health Sciences, University of
Antwerp, Antwerp, Belgium; 7Sleep Disorders Center, Department
of Respiratory Medicine, University of Crete, Heraklion, Greece;
8
Department of Chest Diseases, Ege University Faculty of Medicine,
Izmir, Turkey; 9Department of Medicine and Surgery, University
10
of Milano-­Bicocca, Milan, Italy; Respiratory Failure Unit, G.
Papanikolaou Hospital, Medical School, Aristotle University of
11
Thessaloniki, Thessaloniki, Greece; National Research Council (CNR),
Institute for Biomedical Research and Innovation, Palermo, Italy;
12
Department of Pneumonology, National and Kapodistrian University
13
of Athens, Athens, Greece; PROMISE Department, University of
Palermo, Palermo, Italy
Objectives/Introduction: In order to understand the complexity
of the obstructive sleep apnea (OSA) comorbidities (comorbidome)
and to provide a more comprehensive framework for future disease
management and precision medicine, a network-­based analysis was
applied in data from the ESADA network database.
Methods: Text-­mining analysis of all comorbidities entered in the
ESADA network database (N = 17,199 OSA patients), transcribed
into ICD-­10 codes (v. 2020 ICD-­10-­CM). Associations between co-
morbid conditions in the OSA comorbidome were assessed by means
of network analysis, Risk Ratio (RR) and phi-­correlations. Additional
validations between ICD-­10 codes and ATC codes (OSA polyphar-
macy network) were carried out. All statistical analyses were con-
ducted in R (v. 4.0).
ABSTRACTS
Results: A total of 929 unique ICD-­10 codes belonging to 19 dif-
ferent chapters and 186 subchapters were generated. Overall, arte-
rial hypertension was the commonest comorbidity in patients with
OSA (62%) while 50.4% of the study population had ≥2 comorbidi-
ties, while 29.2% had ≥3 comorbidities (median = 2, max = 14). The
most commonly reported linkages between comorbidities included
the following: arterial hypertension and ischemic heart disease:
RR = 1.64 (CI95% = 1.46–1.83), arterial hypertension and heart fail-
ure: RR = 1.57 (CI95% = 1.27–1.92); overweight-­obesity and type
II diabetes mellitus (RR = 1.71, CI95% = 1.60–1.84), overweight-­
obesity and arterial hypertension: RR = 1.30 (CI95% = 1.26–1.35),
overweight-­obesity and hyperlipidemia: RR = 1.32 (CI95% = 1.29–
1.68); ischemic heart disease and hyperlipidemia (RR = 1.68,
CI95% = 1.58–1.79), and chronic obstructive pulmonary disease and
heart failure (RR = 1.38, CI95% = 1.32–1.45). ICD-­10 and ATC codes
showed good correlation (e.g., E11-­Diabetes Mellitus and A10-­Drugs
used in diabetes; Pearson r = 0.82, p < 0.001) suggesting a good ro-
bustness of the findings.
Conclusions: Network-­
based analysis of the OSA comorbidome
demonstrated a wide range of concomitant disorders, highly preva-
lent multimorbidity and specific association patterns. This type of
analysis can contribute to a better understanding of disease com-
plexity and might be used for prediction of OSA outcomes.
Disclosure: Nothing to disclose.
O95 | Early sleep apnea termination by bone-­
conducted sound stimulation, a new approach to
treat obstructive apnea?
A. Waeber1; P. Arnal2; E. Mignot3; R. Heinzer1
1
CIRS, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland;
2
Research Team, Rythm, San Fransisco; 3Center for Sleep Sciences and
Medicine, Stanford University, Stanford, CA, United States
Objectives/Introduction: Obstructive sleep apnoeas (OSA) usually
end with an oxygen desaturation and/or an arousal. In most epidemi-
ological studies, OSA-­associated oxygen desaturations are stronger
predictors of cardiovascular morbidity than OSA-­associated arous-
als. The aim of this study was to determine if induction of a prema-
ture arousal by a bone-­conducted sound stimulation shortly after
the onset of an event can reduce the magnitude of OSA-­associated
oxygen desaturation.
Methods: Eight severe OSA patients (2 women, 45 [20–68] year-­
old) underwent polysomnography at the Lausanne University Sleep
Centre (CIRS). Short acoustic stimulations were administered every
second sleep apnoea by remote control using a Dreem® headband
worn by the patients. Acoustic stimulations were administered by
bone conduction. The magnitude (%) and the duration(s) of the oxy-
gen desaturations following these prematurely terminated apnoeas
were compared with previous and following non-­acoustic stimulated
sleep apnoea events.
|
      49 of 356
Results: Analysis of 549 paired (stimulated-­unstimulated) respira-
tory events in N1 (14.2%), N2 (69.9%), N3 (4.2%), and REM sleep
(9.6%) showed a 30.3% reduction in oxygen desaturation amplitude
(mean difference ± SD: −1.9 ± 2.8%, p < 0.0001), a 39.6% decrease in
desaturation duration (−5.7 ± 9.2 seconds, p < 0.0001), and a 21.4%
decrease in apnoea duration (−3.4  ±  7.2  seconds, p < 0.0001) in
stimulated apnoeas compared to the previous and subsequent non-­
stimulated apnoea events. When analysed individually, each patient
showed a significant improvement following acoustic stimulation of
events. Sound-­associated discomfort was rated 1.14 ± 1.53 on an 8
points scale (8 = worst). Of the 68.6 ± 38 administered sound stimuli
per patient, only 6.8% of were perceived by the patients. A reduction
in the desaturation amplitude occurred in each sleep stage but was
milder in N3.
Conclusions: Bone-­conducted sound stimuli applied trough a head-
band during the apnoeas decreased duration and magnitude of
OSA-­associated oxygen desaturation. These were well tolerated and
often not perceived by the patient. This new treatment approach
should be further investigated, with monitoring of its effect on car-
diovascular parameters and daytime sleepiness.
Disclosure: Funded by the CIRS research fund. However, P. Arnal is
the research director of ‘Dreem’, Pr. R. Heinzer and Pr. E. Mignot are
members of the medical advisory board of ‘Dreem’ company which
provided for free the headband used to generate the sounds.
O R A L 11 – LE A R N I N G & M E M O RY
O96 | Impact of wake fragmentation on
working memory performance and associated
cerebral correlates in the aged
M. Reyt1,2; M. Deantoni1; F. Collette1,2; A. Lesoinne1; M.
Baillet1; S. Laloux1; E. Lambot1; E. Salmon1; C. Phillips1; M.A.
Bahri1; V. Muto1; G. Hammad1; C. Schmidt1,2
1
GIGA-­CRC in Vivo Imaging; 2Psychology and Neurosciences of
Cognition Research Unit, University of Liège, Liège, Belgium
Objectives/Introduction: Recently developed models of cognitive
ageing explain how the combined effects of adverse and compensa-
tory neural processes produce variable levels of age-­related cogni-
tive decline. These models start to integrate sleep as a modulating
factor of brain structure and function, as well as cognition. Here,
we more specifically assessed whether daytime rest as an index of
altered sleep-­wake regulation affects working memory performance
and its underlying cerebral correlates in the aged.
Methods: Forty-­nine healthy older participants (69 ± 5.9 years, 21
women) performed a Sternberg task in a 3T MRI scanner. Letters set
sizes and thereby memory load ranged from 2 (low load) to 7 (high
load) items. Daytime rest was defined through actimetry, collected
during at least 11 days. The fraction of rest during afternoon was
 |
50 of 356       ABSTRACTS
used as an estimator of wake fragmentation (WF). Working memory
performances and task-­related cerebral correlates were compared
between the highest (HWF group, n = 12) and lowest (LWF, n = 12)
WF quartile. Reported statistics are family-­
wise-­
error corrected
over the entire brain volume (pFWE).
Results: We observed a significant interaction between work-
ing memory load and WF group (F(5) = 4.019, p < 0.01). Post-­hoc
comparisons revealed that the HWF group had significantly lower
performance on the highest memory load condition compared to
the LWF group (set size 7: HWF vs LWF: t(110) = 3.485, p < 0.001).
Concomitantly, higher BOLD activation in the superior parietal lobe
was observed in the LWF group compared to the HWF group at
highest memory load only (pFWE < 0.001).
Conclusions: Our results suggest that wake fragmentation affects
working memory performance at older age. Complementary to that,
brain imaging data reveal under-­
recruitment in task-­
relevant su-
perior parietal regions in individuals characterized by higher wake
fragmentation. Together, these data posit wake fragmentation as a
potential modulator of cognition in the aged and suggest that this
modulation is at least partially mediated through an altered resource
allocation of task-­relevant brain activation.
Disclosure: The authors have no conflict of interest to disclose.
Sources of funding: Belgian Fund for Scientific Research (FNRS),
European Research Council (ERC-­Starting Grant).
O97 | Effect of targeted memory reactivation
on electrophysiological sleep features involved in
motor memory consolidation
J. Nicolas1; B.R. King1; D. Levesque2; L. Lazzouni3; E.
Coffey4; S. Swinnen1; J. Doyon3; J. Carrier5,6; G. Albouy1
1
KU Leuven, Leuven, Belgium; 2CIUSSS-­NIM; 3McGill University;
4
Concordia University; 5Université de Montréal; 6Centre de Recherche
de l'Institut Universitaire de Gériatrie de Montréal, Montréal, QC,
Canada
Objectives/Introduction: Post-­learning sleep is known to enhance
memory consolidation, the process that allows recently acquired
memories to be strengthened. Sleep-­
dependent consolidation is
thought to involve the reactivation of memories during slow-­wave
sleep (SWS) through a temporal coupling among neo-­cortical slow
oscillation (SOs), thalamic spindles (short burst of brain activity in the
sigma band) and hippocampal sharp-­wave ripples (reviewed in Born
and Wilhelm, 2012). Targeted Memory Reactivation (TMR) has been
consistently reported as an efficient experimental manipulation to
further enhance sleep-­dependent consolidation (e.g. Cousins et al.,
2016). This pre-­registered study focuses on the TMR-­induced modu-
lation of spindles and SOs after motor sequence learning (MSL).
Methods: Eighteen healthy participants (age range: 18–27) were
trained on a MSL task involving two bimanual finger tapping se-
quences. At the beginning of each repetition, sequences were cued
by different 100-­ms sounds. Participants were retested on the MSL
after a 90-­minute nap and the following morning. During SWS epi-
sodes in the post-­learning nap, two different auditory cues were
played: one of the two sounds associated to one of the two learned
sequences and one control sound that was not associated to any of
the sequences.
Results: Gains in motor performance speed from MSL training to
retest -­a proxy of memory consolidation-­were significantly larger
for the reactivated sequence as compared to the non-­reactivated
sequence across the two retests (F(1,17) = 4.5; p = 0.049).
Amplitude of the potential evoked by the associated cues was sig-
nificantly higher as compared to those evoked by the unassociated
cues in a 280 ms window centred around 1.4 s post-­cue (p = 0.036,
cluster-­
based permutations correction for multiple comparison).
Power of evoked activity between 14 and 18 Hz (around fast spindle
frequency) tended to be greater in a 170 ms window centred around
1.50 s following associated as compared to control cues (p < 0.05
uncorrected). Finally, spontaneous SOs had a significantly bigger
peak-­
to-­
peak amplitude when occurring during blocks of associ-
ated, as compared to non-­associated, cues (one-­t ailed paired t-­test,
t(17) = 2.5, p = 0.011).
Conclusions: Our results provide evidence for TMR-­induced entrain-
ment of plasticity markers during sleep that may underlie the reacti-
vation of motor memory and ultimately its enhanced consolidation.
Disclosure: No conflict of interest to be declared. This work was
supported by the Belgian Research Foundation Flanders (FWO;
G0D7918N), Healthy Brain for Healthy Lives Discovery Grant
Program from the Canada First Research Excellence Fund and in-
ternal funds from KU Leuven. GA also received support from FWO
(G0B1419N, G099516N, 1524218N) and Excellence of Science
(EOS, 30446199, MEMODYN, with SS). JN received salary sup-
port from these grants and will be in September a postdoctoral re-
searcher Marie Skłodowska-­Curie Actions – Seal of Excellence of
the Research Foundation – Flanders. Financial support for author
BRK was provided by the European Union's Horizon 2020 research
and innovation program under the Marie Skłodowska-­Curie grant
agreement (No 703490) and a postdoctoral fellowship from FWO
(132635).
O98 | The effect of sleep on associative novel
word learning in healthy young adults
E. Schimke1; A. Angwin1; S. Gomersall1; D. Copland1,2
1
School of Health and Rehabilitation Sciences; 2Centre for Clinical
Research, The University of Queensland, Brisbane, QLD, Australia
Objectives/Introduction: It has been established that sleep plays a
role in memory consolidation and can benefit some forms of word
learning. In the present study, we aimed to investigate the effect
of sleep on associative novel word learning in healthy adults, and
whether this effect is influenced by the provision of additional
ABSTRACTS
semantic information during encoding. We hypothesised that de-
layed word recall accuracy would be superior when a period of
overnight sleep followed the learning session, and that semantic in-
formation would boost novel word learning.
Methods: In this between-­
group randomised study, 75 healthy
adults aged between 18–30 years (mean age = 21.4, SD = 2.6) were
required to learn the names of novel objects. Names consisted of a
novel word (e.g., Snaze) paired with either two semantic attributes
(semantic condition) or two proper names (name condition). The
training session involved five learning phases, with tests of recall fol-
lowing each phase. Recall was then tested again 12 hours later after
a period of overnight sleep (n = 36) or daytime wakefulness (n = 39).
Participant levels of alertness were measured at both sessions
via a psychomotor vigilance task (PVT) and subjective self-­report
measures (sleepiness scale), and participant total sleep time was
monitored outside of the testing sessions via actigraphy (Actigraph
wGT3X-­BT) and subjective self-­report measures (sleep diary and
standardised questionnaires).
Results: A repeated measures ANOVA (Group x Condition x Trial)
was conducted to analyse recall accuracy immediately post-­learning.
Recall accuracy improved for both groups across the five learn-
ing phases (p < 0.001), with no other differences for group (sleep,
wake) or condition (semantic, name). Independent T-­Tests were used
to analyse recall accuracy after the 12 hour delay and results indi-
cated a significantly higher recall accuracy for the Sleep group (rela-
tive to the Wake group) for both the semantic (p = 0.041) and name
(p = 0.004) conditions.
Conclusions: These results extend our current understanding of how
sleep benefits different forms of word learning, showing that a pe-
riod of overnight sleep can boost the acquisition of novel words en-
coded with or without semantic information in healthy young adults.
Disclosure: Nothing to disclose.
O99 | Sleep benefits memory retention
by enhancing functional brain activity in the
posterior medial memory network, thalamus and
striatum during recall
S. Brodt1,2; M. Schönauer3; M. Erb2; K. Scheffler2; S. Gais1
1
Institute of Medical Psychology and Behavioral Neurobiology,
University of Tübingen; 2High-­Field Magnetic Resonance, Max
3
Planck Institute for Biological Cybernetics, Tübingen; Department of
Psychology, University of Freiburg, Freiburg, Germany
Objectives/Introduction: Sleep has robustly been shown to benefit
declarative memory consolidation on a behavioral level, the underly-
ing mechanisms in terms of functional activation of mnemonic brain
networks however remain unclear. While most report an increase in
cortical activation across sleep, results on subcortical involvement
diverge (Gais et al 2007; Himmer et al 2019; Takashima et al 2009).
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      51 of 356
Here, we aimed to assess role of sleep on memory-­related brain ac-
tivity in cortical and subcortical networks.
Methods: Participants repeatedly learned object-­place associations
in two sessions spaced 13 hours apart. The wake group (n = 19) en-
countered task session 1 in the morning, spent the day awake and
returned for session 2 in the evening. The sleep group (n = 20) com-
pleted session 1 in the evening, slept at home with mobile polysom-
nography and returned the next morning. During the memory task,
functional brain activity was recorded via fMRI.
Results: Behaviorally, sleep benefitted memory retention
(F(1,37) = 6.24, p = 0.017, η2 = 0.144): While there was no difference
in performance between the two groups in the last recall of session
1, the wake group remembered significantly less associations during
the first recall of session 2 (t(37) = 2.1, p = 0.041). This interaction
was mirrored in functional brain activity across a network span-
ning visual cortex, precuneus, as well as subcortical regions like the
striatum, thalamus and hippocampus (psvc < 0.001). When exclud-
ing the potential confounding effect of time spent awake, only the
precuneus, striatum and thalamus retained significant effects. These
were characterized by a robust increase in activation levels from ses-
sion 1 to session 2 in the sleep group, accompanied by a transient
decrease during the first recall repetition of session 2 in the wake
group. Furthermore, upregulation of activity in these areas was as-
sociated with behavioral benefits, as a stronger increase in activity
across the retention interval correlated with better memory reten-
tion (r = 0.308–0.405, p < 0.05).
Conclusions: Together, our analyses show that sleep might benefit
memory retention by enhancing memory-­related brain activity in
a brain-­
wide mnemonic network encompassing posterior medial
cortex as well as subcortical regions like the thalamus and striatum.
These effects cannot be explained by general differences in time
spent awake at the time of data recording.
Disclosure: Nothing to disclose.
O100 | A longitudinal investigation of cognitive
performance and sleep spindles in young
adolescents
C. Reynolds1; M. Short1; R. Bodizs2; M. Heath1; C.
Richardson3; M. Gradisar1
1
College of Education, Psychology & Social Work, Flinders University,
Adelaide, SA, Australia; 2Institute of Behavioural Sciences, Semmelweis
University, Budapest, Hungary; 3Centre for Sleep Science, School of
Psychological Science, University of Western Australia, Perth, WA,
Australia
Objectives/Introduction: Adolescents experience significant cortical
development as well as changes to their sleep patterns, with sleep spin-
dles being one facet of EEG that may reflect these changes. Previous
studies have mostly used cross-­
sectional designs or investigated
EEG power spectra exclusively, with limited investigations of specific
 |
52 of 356       ABSTRACTS
spindle characteristics in the transition from childhood to adolescence.
Furthermore, sleep spindles have been implicated in cognitive func-
tioning across many age groups, however the nature of the relationship
in childhood is less clear, and often opposite, to that seen in adolescents
and adults. The developmental trajectory of spindle characteristics and
the relationship between spindles and cognition was therefore tested
in this longitudinal study of emerging adolescents.
Methods: Adolescents attended the sleep laboratory for one night
of sleep monitoring every 6 months over an 18-­month period (mean
age = 10.3 yrs, n = 20). Cognitive performance domains of working
memory and fluid intelligence were investigated, along with sleep
spindle characteristics (density, duration, amplitude and frequency,
separated for slow and fast spindles).
Results: Working memory performance improved significantly over
time, F(3,49) = 4.63, p = 0.006, while slow and fast spindle frequency
significantly increased over the four time points, F(54) = 8.64,
p < 0.001 and F(54) = 3.20, p = 0.03, respectively, supporting previ-
ous findings. There was no significant variation in other cognitive
or spindle characteristics. Spindle parameters and cognition did not
show significant cross-­sectional associations above corrections for
multiple comparisons, contrary to past findings. When considering
the population effect size for associations between spindles and cog-
nition, however (r = 0.15 to 0.27; Reynolds et al., 2018; Ujma, 2018),
two patterns emerged. Both slow and fast spindle frequency con-
sistently related to better fluid intelligence performance, with vary-
ing degrees of strength (r ranging from 0.15 to 0.46). Longitudinally,
both working memory and fluid intelligence improvements were re-
lated to changes in slow and fast spindle frequency over time, how-
ever these did not show consistent or meaningful patterns.
Conclusions: Spindle characteristics may show developmental
changes later in adolescence, aligning with expected network re-
finement and synaptic pruning, while early adolescence shows only
small changes. Furthermore, the relationship between sleep spindles
and cognition may be unstable in early adolescence due to the com-
plex brain reorganisation in this developmental period.
Disclosure: This work was funded by the Australian Research
Council.
References:
Reynolds, Short & Gradisar (2018) Sleep spindles and cognitive per-
formance across adolescence: A meta-­
analytic review. Journal of
Adolescence.
Ujma, P. P. (2018). Sleep spindles and general cognitive ability-­A meta-­
analysis. Sleep Spindles & Cortical Up States.
O101 | Sleep to stop the decline of planning and
risk-­related decision-­making ability during the day
M.L. Wong1; E.Y.Y. Lau2,3; Y.C. Lam2
1 2
Psychology, University of Exeter, Exeter, United Kingdom; Psychology,
Education University of Hong Kong; 3Psychiatry, University of Hong
Kong, Hong Kong, Hong Kong
Objectives/Introduction: With accumulating evidence that sleep is
important to optimal functioning of the prefrontal cortex, we aim to
study how daytime napping impacts on the dynamic changes of risk-­
related decision making and planning performance during the day.
Methods: An experimental nap paradigm was used in 145 emerging
adults (20.1 ± 1.5 years, 63% female) on planning (Tower of London
test, TOL) and risk-­related decision making (Risky-­Gains Task, RGT).
Participants completed the TOL and RGT twice and were randomized
to sleep (Sleep group, n = 107), or stay awake (Wake group, n = 38) for
90 minutes between the two sessions. Participants also completed a
sleep diary and wore an actigraph-­watch for 7 days to control for base-
line sleep-­wake behaviors, and the psychomotor vigilance test (PVT)
for vigilance prior to each test session. Adjustment for multiple com-
parisons was performed using Benjamini-­Hochberg procedure.
Results: Mixed factorial ANOVA showed an interaction effect of
time (pre/post) and group (Sleep/Wake) on PVT mean reciprocal re-
sponse time, F(1,135) = 22.95, p < 0.001, number of steps used in TOL,
F(1,133) = 4.06, p = 0.046, and RGT response time in making risky
choices, F(1,114) = 5.00, p = 0.027. Follow-­up analyses showed that
at post-­test, the Sleep group had improved vigilance, t(100) = −5.07,
p < 0.001 and stable response time in making risk-­related decisions,
t(84) = 1.60, p = 0.113 while the Wake group became less vigilant,
t(35) = 2.26, p = 0.033 but faster in risk-­related decision-­making,
t(29) = 2.58, p = 0.015. On the TOL, a significant between-­group
difference in change scores showed that the Wake group tended to
take more steps at post-­test, while the Sleep group changed in the
other direction, F(1,133) = 4.06, p = 0.046, with the decrease in steps
correlating with more C3 fast spindles, r(87) = −0.24, p = 0.025, and
change in RGT response time with number, r(74) = 0.27, p = 0.021,
and density, r(74) = 0.34, p = 0.004, of F3 fast spindles.
Conclusions: Across the day, a profile of decreasing vigilance, de-
creasing planning ability and faster risk-­taking time was revealed.
Such pattern appeared to be reversed with a daytime sleep opportu-
nity, particularly with frontal and central sleep spindles, supporting
the important role of sleep in substantiating frontal-­lobe functioning
from a behavioural perspective.
Disclosure: This study is funded by the General Research Fund
(EdUHK#18619616, EdUHK#17612015) of the Research Grant
Council, Hong Kong.
O102 | The preferential processing of relevant
sounds continues during NREM sleep
M.S. Ameen1; D.P. Heib1; C. Blume2; R. del Giudice3; M.
Schabus1
1
Psychology, Laboratory for Sleep, Cognition and Consciousness
Research, University of Salzburg, Salzburg, Austria; 2University of
Basel, Basel, Switzerland; 3University of Milan, Mialn, Italy
Objectives/Introduction: The sleeping brain continues to process
sensory information from the environment and elicits different
ABSTRACTS
responses to auditory stimuli of varying saliency levels, i.e. differ-
ent names and/or voices. However, whether these responses serve
sensory processing or sleep protection remains an open ques-
tion. In this study, we investigated sleep-­specific brain responses
to auditory stimuli of different characteristics and measured the
auditory-­
induced sleep-­
specific responses such as; K-­
complexes,
sleep spindles and micro-­arousals, during non-­rapid eye movement
(NREM) sleep.
Methods: We recorded polysomnography data from 17 healthy sub-
jects in a full night of sleep with auditory stimulation. Stimuli were
the subject's own name and two unfamiliar names, spoken by either
a familiar voice (FV) or an unfamiliar voice (UFV). We compared the
amounts of triggered K-­complexes, spindles and micro-­arousals be-
tween different names and voices.
Results: During NREM sleep, the brain responded preferentially to
UFV stimuli by eliciting more K-­complexes (F(1,16) = 15, p = 0.001,
ƞp2 = 0.48) followed by more micro-­
arousals (F(1,16) = 10.56,
p = 0.005, ƞp2 = 0.40). When K-­complexes were triggered, UFV stim-
uli evoked larger event-­related potential response (∑t(16) = −409.46,
p = 0.005), that started with a deeper inhibition that was followed
by a stronger excitation. Moreover, spectral analysis revealed that
UFV stimuli triggered higher activity in a broadband frequency
range (from 0.5 to 12 Hz: ∑t(16) = 8325, p = 0.002, from 15–23 Hz:
∑t(16) = 4778, p = 0.01) . Interestingly, these differences in brain re-
sponses between UFV and FV disappeared when no K-­complexes
were triggered.
Conclusions: Our findings suggest that the sleeping brain continues
to preferentially process auditory information during NREM sleep
with a central role for K-­complexes. Moreover, our results point to-
wards a dual function for K-­complexes in maintaining a trade-­off be-
tween sleep protection and sensory processing to enable the brain
to benefit as much as possible from sleep.
Disclosure: Nothing to disclose.
N I G HTM A R E TH E R A PY A N D P S YC H I ATRY:
FRO M BA S I C R E S E A RC H TO C LI N I C A L
A PPLI C ATI O N S
O103 | Nightmare distress, nightmare
frequency, and beliefs about nightmares
M. Schredl
Sleep Laboratory, Central Institute of Mental Health, Mannheim,
Germany
Introduction: The diagnosis of a nightmare disorder is based on clini-
cally significant distress caused by the nightmares and, therefore,
empirical research should focus not only focusing on factors asso-
ciated with nightmare frequency but also on studying factors that
affect nightmare distress.
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      53 of 356
Methods: Overall, 2056 persons (1212 woman, 844 men) com-
pleted the online survey (a population-­based sample). A reliable 6-­
item scale measuring beliefs about nightmares was developed, e.g.,
‘Nightmares contain clues to unconscious fears’.
Results: The beliefs about nightmares scale contributed to night-
mare distress independently from nightmare frequency. The ordinal
regression showed that nightmare frequency provided the strongest
contribution to nightmare distress (standardized estimate = 0.4323,
Chi-­Square = 241.9, p < 0.0001) but also beliefs about nightmares
(standardized estimate = 0.3239, Chi-­Square = 144.2, p < 0.0001), and
female gender (standardized estimate = 0.1613 , Chi-­Square = 37.5,
p < 0.0001) were related to nightmare distress.
Conclusions: From a clinical viewpoint, it would be desirable to carry
out intervention studies looking at the effect of psychoeducation
about nightmares on nightmare frequency and nightmare distress.
Disclosure: Michael Schredl received research funding from Idorsia.
O104 | Thought suppression during the day
and dream quality at night in patients that suffer
from PTSD
A. Gieselmann1; M. Böhm1; R. Bering2; R. Pietrowsky1
1
Heinrich Heine University Düsseldorf, Düsseldorf; 2Center for
Psychotraumatology, Alexianer Krefeld GmbH, Krefeld, Germany
Thought suppression is a maladaptive cognitive strategy frequently
observed in patients that suffer from posttraumatic stress disorder
(PTSD). It describes the attempt to deal with undesirable cognitive
content by deliberate suppression of the unwanted content and
leads to rebound effects as soon as the individual stops his/her at-
tempt. In our talk, we would like to address the consequences of
thought suppression on sleep quality and dream quality. In study I,
a questionnaire investigation, thought suppression was associated
with more severe PTSD symptoms, worsened sleep quality, and
more vivid, realistic, and burdensome dreams. In study II, patients
were asked to keep sleep and dream diaries. Analyses indicated that
suppression of trauma-­related thoughts during the previous day let
to worsened sleep quality as well as to more realistic and more dis-
tressing dreams during the following night. The suppression of daily
hassles during the day did not cause such effects at night. The re-
sults indicate that not the trauma per se causes sleep difficulties in
patients that suffer from PTSD, but the way the patients deal with
unwanted trauma-­related thoughts affects their sleep and dream.
Thus, treatment should address thought suppression in order to im-
prove sleep quality and dream quality in patients that suffer from
PTSD.
Disclosure: Nothing to disclose.
 |
54 of 356       ABSTRACTS

O105 | The efficacy of imagery rehearsal and to change it to a more positive narrative. The new contents are

therapy and prazosin in the treatment of then rehearsed using imagery techniques. To our knowledge, this
study is the first randomized controlled trial to investigate the feasi-
posttraumatic nightmares: a meta-­analysis
bility and efficacy of IRT in psychiatric inpatients. For this purpose,
60 inpatients with different psychiatric disorders and self-­reported
J. Lancee
distressing nightmares are randomly assigned to an IRT or Treatment
University of Amsterdam, Amsterdam, The Netherlands
as usual group. The adapted IRT intervention consists of one to two
sessions and daily imagery exercises. Nightmare frequency, night-
Prazosin and imagery rehearsal therapy (IRT) are the two main treat- mare distress, and nightmare intensity are assessed retrospectively
ments of posttraumatic nightmares. IRT was recently listed by the and prospectively pre-­and post-­IRT, using validated questionnaires
American Academy of Sleep Medicine (AASM) task force as the rec- and a dream diary. Preliminary results will be presented. We hope
ommended treatment for trauma-­related nightmares. At the same that our study will help design effective and feasible protocols for
time the AASM downgraded the recommendation of prazosin to ‘may the treatment of nightmares in this severely afflicted population.
be used’. The problem is that this recommendation was based on a Disclosure: Nothing to disclose.
single prazosin trial and not on a meta-­analytic review of all available
trials. In the current meta-­analysis eight studies on IRT and seven
studies on prazosin (N = 1.078) were analysed based on the random CO N V E RG E N C E O F M E D I C A L A N D D E NTA L
effects model. In this meta-­analysis there were no significant differ- S LE E P M E D I C I N E: M OV I N G TOWA R D A
ences in effect between IRT and prazosin on any of the outcomes. D I S TI N C T I NTE R D I S C I PLI N A RY FI E LD
Relative to control groups, a moderate to large effect on nightmare
frequency (g = 0.61), posttraumatic stress symptoms (g = 0.81), and
sleep quality (g = 0.85) was observed for prazosin. Small to moderate O107 | CPAP or oral appliances for OSA: time
effects on nightmare frequency (g = 0.51), posttraumatic symptoms
for a personalised approach
(g = 0.31), and sleep quality (g = 0.51) were observed for IRT. This
meta-­analysis thus clearly shows efficacy of both treatment formats.
P. Cistulli
Based on these finding it seems that it may have been premature to
Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
downgrade the recommendation for prazosin.
Article published as:
Yücel, D.E., van Emmerik, A.A.P., Souama, C., & Lancee, J. Oral appliances (OA) have emerged as the leading alternative to
Comparative efficacy of imagery rehearsal therapy and prazosin positive airway pressure (PAP) for Obstructive Sleep Apnoea (OSA)
in the treatment of trauma-­related nightmares in adults: A meta-­ treatment. There is a strong evidence base demonstrating OA ther-
analysis of randomized controlled trials. Sleep Medicine Reviews, in apy improves OSA in the majority of patients, including some with
press. more severe disease. They are generally well tolerated, and patients
Disclosure: Nothing to disclose. often prefer OA over PAP treatment. Despite the superior efficacy
of PAP over OA, randomized controlled trials comparing the two in-
dicate similar improvement in health outcomes such, as sleepiness,
O106 | Treatment of nightmares in psychiatric quality of life, driving performance, blood pressure, and other car-
diovascular measures. The evidence base strongly supports the use
inpatients with imagery rehearsal therapy: a
of OA therapy in the management of OSA. The field needs to move
randomized controlled trial
toward a personalised approach that takes into account patient pref-
erence and phenotypic characteristics, in order to optimise patient
T. Maeder1,2; R. Steil3; M. Colla2; E. Seifritz2; B. Kleim1,2
1
outcomes.
Department of Experimental Psychopathology and Psychotherapy,
Disclosure: Dr. Cistulli has an appointment to an endowed academic
University of Zurich; 2Psychiatric Hospital of the University of
Chair at the University of Sydney that was established from ResMed
Zurich, Zurich, Switzerland; 3Department of Clinical Psychology and
funding. He has received research support from ResMed, SomnoMed,
Psychotherapy, Goethe University Frankfurt, Frankfurt, Germany
Bayer, and Zephyr Sleep Technologies. He has been a consultant/ad-
viser to ResMed, SomnoMed, Zephyr Sleep Technologies, Bayer, and
Nightmares are common across psychiatric disorders. If not Signifer Medical technologies.
treated specifically, they can persist and function as a risk factor
and an exacerbating factor for psychiatric symptoms. Several spe-
cific treatments for nightmares are available. One evidence-­based
cognitive-­
behavioral-­
oriented treatment is Imagery Rehearsal
Therapy (IRT). IRT asks patients to identify a distressing nightmare
ABSTRACTS
O108 | Sleep bruxism and sleep comorbidities:
a dental-­medical perspective
G. Aarab
Orofacial Pain and Dysfunction, Academic Centre for Dentistry
Amsterdam (ACTA), Amsterdam, The Netherlands
Sleep bruxism (SB) is a repetitive jaw-­muscle activity characterized
by clenching or grinding of the teeth and/or by bracing or thrusting
of the mandible during sleep. Based on a systematic review on the
epidemiology of SB, the prevalence of SB in adults is 12.8 ± 3.1%.
The potential negative consequences of SB described in literature
are, for example, headache upon awakening, temporomandibular
pain complaints, severe mechanical tooth wear, and tooth/dental
restoration /implant fractures/failures. Interestingly, nowadays, also
some positive consequences of SB are suggested, for example, the
condition having a protective role in maintaining airway patency in
obstructive sleep apnea patients and promoting saliva secretion by
mechanical salivary (parotid) gland stimulation for esophageal acid
clearance.
SB is a co-­morbid condition of many sleep-­related disorders.
Insight into the underlying mechanism of these relationships may
assist the clinician in making a distinction between the primary and
secondary forms of SB. In the absence of an underlying medical eti-
ology, SB is considered primary, or idiopathic, whereas secondary
SB is associated with a medical condition. The distinction between
these two forms is important, as the management may be distinct.
In cases where the primary form of SB has harmful consequences
management of SB is often necessary. However, when SB is a co-­
morbid condition of other sleep-­related disorders, management of
the associated medical conditions by an expert physician should be
the focus. It is to be expected that the management of the sleep-­
related disorder may prevent or reduce SB and its consequences on
dental and general health. This presentation will provide an over-
view of the current evidence on SB as a co-­morbid condition of other
sleep-­related disorders.
Disclosure: Nothing to disclose.
O109 | Challenges in dental sleep medicine for
the 2020 Decade: a PhD student perspective
A. Herrero Babiloni
Experimental Medicine, McGill University, Montreal, QC, Canada
Dental sleep medicine is a discipline comprehending conditions such
as sleep breathing disorders (e.g., sleep apnoea), sleep bruxism, oro-
facial pain and sleep-­related complaints, and to some extent gastro-­
oesophageal reflux disorder and/or insomnia. Indeed, dentists can
significantly contribute to the screening and management of those
conditions, which in some cases have severe consequences (e.g.,
|
      55 of 356
sleep apnoea). Nevertheless, dental sleep medicine education is not
yet integrated in many dental schools, which is a significant obstacle
for the progress of the field. Thus, in this lecture avenues to improve
dental sleep medicine education will be provided. Moreover, den-
tists should be familiar with phenotyping and endotyping strategies
in order to contribute toward personalized medicine and further
improve interdisciplinary patient care. Besides evaluating important
intraoral and craniofacial features, taking into account anatomical
and behavioral characteristics ‘outside the mouth’ such as obesity,
behaviors, sleep, mental health, or sociodemographic variables, can
increase treatment efficacy while minimizing side effects in the
management of sleep disorders. Some examples are the avoidance
of opioids and/or benzodiazepines prescriptions if the patient pre-
sents sleep apnoea, or caution in the use of mandibular advance-
ment devices if painful temporomandibular disorders are present.
Awareness and familiarization with machine learning and artificial
intelligence approaches can advance not only dental sleep medicine
research, but also clinical care.
Disclosure: Nothing to disclose.
S LE E P A S R E S O U RC E O F M E NTA L H E A LTH
O110 | Does restless REM sleep ruin resilience
and recovery across mental disorders?
E. Van Someren1,2
1
Department of Sleep & Cognition, Netherlands Institute for
Neuroscience; 2Departments of Psychiatry and Integrative
Neurophysiology, Amsterdam UMC, Vrije Universiteit, Amsterdam, The
Netherlands
Insomnia conveys the strongest transdiagnostic risk for mental dis-
orders. Insomnia moreover aggravates their severity, and impedes
recovery and resilience to relapse. Understanding the mechanisms
underlying the adverse effects of insomnia could be our best chance
to discover actionable transdiagnostic targets for a better manage-
ment of mental disorders.
Integrated findings from animal models to patient intervention
studies suggest a key role of restless REM sleep (Wassing, PNAS
2016;113:2538; Brain 2019;142:1783; Sleep 2019;42:zsy268; Curr
Biol 2019;29:2351; Van Someren 2020 TINS and Physiol Rev in
press). In interaction with other sleep stages, sound REM sleep seems
pivotal for successful overnight adaptation to daytime distress. REM
sleep provides the brain with a time window of unique neuromodu-
latory conditions for synaptic plasticity. Only during REM sleep the
locus coeruleus is completely silenced, allowing synaptic processes
to occur in absence of noradrenalin. Absence of noradrenalin affects
plasticity across all levels, from receptor subunit replacement to sys-
tems consolidation and adaptation.
 |
56 of 356       ABSTRACTS
Many people with mental disorders show Restless REM sleep
and may never experience the unique noradrenalin time-­out. We
hypothesize that an incomplete noradrenalin time-­out during REM
sleep impedes the synaptic plasticity processes that are required
for successful overnight amelioration of emotions including stress,
tension, sadness, fear and anxiety – and consequently the recovery
from PTSD, insomnia, depression and anxiety disorders. The ul-
timate consequence of maladaptive plasticity is that one might be
better of without REM sleep than to experience restless REM sleep.
This is supported by beneficial effects of REM suppression by anti-
depressants or by sleep restriction as part of cognitive behavioral
therapy for insomnia.
The hypothesis generates a research agenda. First, one would
like to develop and validate a better index of nocturnal noradrener-
gic activity than currently provided by standard polysomnographic
measures. Second, this index can be used to evaluate whether al-
tered restless REM mediates the effects of sleep interventions on
mood. Third, pharmacological interventions could aim at suppress-
ing noradrenergic activity especially in the second REM-­rich part
of the night. Importantly, the hypothesis allows for detailed animal
models to reveal the role of noradrenalin time-­outs in the synaptic
plasticity required for adaptation to emotional distress.
Disclosure: Nothing to disclose.
O111 | Rapid eye movement sleep derived
biomarkers of depression
T. Mikoteit1,2; M. Zeising3,4; A. Steiger3; M. Hatzinger1,2
1 tion is to show data on prevalence of insomnia, excessive daytime
Psychiatric Services Solothurn|KPPP, Solothurner Spitäler, Solothurn;
2 sleepiness, restless legs syndrome and sleep apnea in patient with
Department of Medicine, University of Basel, Basel, Switzerland;
3 4
Max Planck Institute of Psychiatry, Munich; Centre of Mental Health,
Klinikum Ingolstadt, Ingolstadt, Germany
Introduction: Rapid eye movement (REM) sleep is a unique source
for biomarkers of treatment outcome of major depression: REM-­
sleep related heart rate variability (HRV) and QEEG derived prefron-
tal theta cordance in REM-­sleep are associated to both, aberrant
noradrenergic activity as well as insufficient frontocingulate regula-
tion of amygdala activity [1]. The aim of this study was to examine,
if (1) prefrontal cordance would predict response and (2) if provid-
ing this biomarker prospectively would increase the response rate.
Finally, we compared biomarker properties of cordance with that of
sleep stage related HRV.
Methods: Thirty-­nine adult in-­patients with major depression at the
start of a new antidepressant (AD) trial were randomized either to
the intervention group (IG, N = 18) or the control group (CG, N = 21).
Prefrontal theta-­cordance in REM sleep and sleep stage related HRV
were assessed from a PSG at week one of treatment. Only in the IG,
the cordance was provided prospectively for guidance of treatment.
Response to treatment was assessed at week five, with a ≥50% re-
duction of baseline Hamilton Depression score meant response.
Results: Prefrontal theta-­Cordance predicted response to treatment
with a positive predictive value of 0.83 and non-­response with a pre-
dictive value of 1.0. The IG had a higher response rate than the CG
(p < 0.05). Variables of sleep stage related HRV at week one did not
predict response.
Conclusion: Prefrontal theta-­cordance in REM sleep is suitable for
response prediction in a clinically relevant way after only 1 week of
antidepressant therapy. The still preliminary results of this ongoing
study suggest that cordance has the capability to increase treatment
response in in-­patients.
Reference:
[1] Pawlowski et al. Heart Rate Variability and Cordance in Rapid
Eye Movement Sleep as Biomarkers of Depression and Treatment
Response. J Psychiatr Res 2017; 92:64–73.
Disclosure: Nothing to disclose.
O112 | Disrupted sleep and psychopathology
in schizophrenia
A. Wichniak
Third Department of Psychiatry and Sleep Medicine Centre, Institute of
Psychiatry and Neurology, Warsaw, Poland
Introduction: Disturbed sleep is a common symptom in schizophre-
nia and it is widely accepted that schizophrenia disrupts circadian
sleep rhythm and is associated with insomnia especially in periods
of schizophrenia acute exacerbation. The aim of the presenta-
schizophrenia.
Methods: The presentation is based on three studies in over 230
patients with schizophrenia. The patients were assessed with ac-
tigraphy, type III portable respiratory monitors and clinical rating
scales. Results from patients were compared to healthy controls and
analysed with regard to clinical symptoms of schizophrenia, demo-
graphic data and kind of antipsychotic medication.
Results: Patient with schizophrenia were found to have increased
time in bed and low daytime activity, this last effect was regardless
of the kind of pharmacological treatment. Sleep apnea was found
to be found more frequent in obese schizophrenia patients than in
those consecutively admitted to hospital (45% vs. 22%). Patients
with sleep apnea had higher results in assessments of negative
symptoms, cognitive deficits and daytime sleepiness. Moderate RLS
symptoms were found in 20% and severe in 5% of examined patients.
Conclusions: Patients with schizophrenia are at high risk of sleep
disorders. Behavioural interventions have to be considered as im-
portant methods for treatment of sleep disorders in these patients.
Additionally the patients should be screened for OSA as it has a neg-
ative influence on psychiatric symptoms and may contribute to the
higher mortality of these patients.
Disclosure: Nothing to disclose.
ABSTRACTS
O113 | The effect of psilocybin on sleep
D. Urbaczka Dudysová1,2; J. Kopřivová1,2; K. Janku1,2; M.
Smotek1,2; E. Saifutdinova1,3; J. Bušková1,2; M. Brunovský1,2;
P. Zach1; J. Korčák1,2; V. Andrashko1,2; M. Viktorinová1; F.
Tylš1; A. Bravermannová1; T. Páleníček1,2; J. Horáček1,2
1
National Institute of Mental Health, Klecany; 2Third Faculty of
Medicine, Charles University in Prague; 3Czech Technical University,
Prague, Czech Republic
Objective: Psilocybin is a psychedelic drug currently investigated for
its potential antidepressant properties. As in other antidepressant
drugs and interventions, sleep may interact with the antidepressant
effect of psilocybin through neural plasticity. The aim of this study
was to evaluate changes in subjective and objective sleep character-
istics associated with psilocybin administration.
Methods: Twenty healthy volunteers (10 women, age 28–53,
M = 36 ± 8.1 years) were enrolled in the present sleep experiment
as part of a larger ongoing study registered by the State institute
for drug control under the EudraCT No. 2012-­0 04579-­37. All par-
ticipants underwent an adaptation night and a whole-­night sleep
recording after both, placebo and psilocybin session, i. e. approxi-
mately 12 hr after the placebo/psilocybin ingestion. After each ex-
perimental night subjective and objective sleep characteristics were
evaluated. Sleep macrostructure, first sleep cycle slow-­wave activity
(SWA) and EEG spectral power were compared between the experi-
mental nights.
Results: No significant changes in subjective total sleep time or
sleep quality were observed. However, subjects perceived times
to fall asleep as longer (10.5 min on average, p = 0.028) during the
night after psilocybin administration compared to placebo condition.
Objective sleep analysis revealed prolonged REM sleep latency after
psilocybin administration (p = 0.048) and an overall tendency to
REM sleep suppression. SWA in the first sleep cycle was found to be
significantly reduced after psilocybin administration in comparison
to placebo condition.
Conclusion: The changes of REM sleep observed after psilocybin
administration correspond with the acute effect of antidepressants
and are congruent with evidence for antidepressant properties of
psilocybin. Contrary to our expectations, our data did not provide
evidence for sleep-­related neuroplastic changes. This might be due
to longer pharmacological dynamics of psilocybin compared to other
psychedelic drugs promoting SWA, e.g. ketamine or ayahuasca.
Possibly, sleep-­related markers of neuroplastic changes might be ob-
served at a longer time interval after drug ingestion.
Disclosure: No conflict of interest. This work was supported by
Ministry of Health of the Czech Republic, grants NV18-­07-­0 0272,
Ministry of the Interior VI20172020056 and by the project ‘Progres
Q35’ of the 3rd Faculty of Medicine, Charles University in Prague.
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S LE E P, AG E I N G A N D
N EU RO D EG E N E R ATI O N : FRO M
M O LECU L A R I N S I G HT S TO N E W
TR E ATM E NT S
O114 | Local and global aspects of sleep
regulation: from single cell rest to network
homeostasis
V. Vyazovskiy
Department of Physiology, Anatomy and Genetics, University of
Oxford, Oxford, United Kingdom
Sleep and circadian rhythmicity arise from a dynamic interplay
across brain-­
wide circuitries, which allow coordinating intrinsic
homeostatic needs with environmental contingencies. Historically,
sleep was viewed as a global phenomenon imposed on the organism
from a limited set of subcortical neural centres, yet the role of local,
activity-­dependent processes in sleep control is increasingly appre-
ciated. The need for sleep (‘sleep pressure’) increases gradually dur-
ing waking, as a function of time spent awake, but dissipates during
subsequent sleep, reaching the lowest levels just before awakening.
It has therefore been proposed that sleep is necessary for various
restorative processes, which include metabolic recovery or synaptic
function.
Despite decades of research many fundamental questions remain,
such as why sleep deprivation impacts brain function and what are the
specific mechanisms that convey the benefits of sleep to the brain. It
was proposed that the most important role of sleep is to provide indi-
vidual neurons with a period in which to perform processes of cellular
maintenance that are required after periods of elevated synaptic activ-
ity. In particular, sleep may enable neurons to deal with cellular stress
associated with the accumulation of misfolded proteins in the lumen
of the endoplasmic reticulum – so called ‘ER stress’. Whilst most cells
in the body can presumably undergo ‘rest’ relatively independently, it
is proposed that neurons must do it together due to their extensive
interconnectivity. Thus, rest at the single neuron level requires both
synchronised network activity and withdrawal from the environment
– the typical features of global sleep.
Numerous human studies have demonstrated that ageing leads
to an overall reduced ability to obtain deep restorative sleep, which
has been suggested to play an important role in the development
of age-­related neurodegenerative disorders and cognitive decline.
The biological significance of age-­dependent changes in sleep is un-
known, but may reflect a diminished sleep need, a reduced capac-
ity to generate deep sleep stages or a weakening of the circadian
clock. Understanding the effects of ageing on local and global as-
pects of sleep regulation will inform studies that aim to target sleep
as a means of preventing cognitive decline and neurodegenerative
disorders.
Disclosure: Nothing to disclose.
 |
58 of 356       ABSTRACTS
O115 | Sleep, aging, and cellular health: aged-­
related changes in sleep and protein homeostasis
N. Naidoo
Perelman School of Medicine, University of Pennsylvania, Philadelphia,
PA, United States
Objectives/Introduction: Aging is best-­
known risk factor for most
neurodegenerative diseases of which abnormal protein aggregation is
a hallmark. It is known that across aging, sleep quality becomes less
efficient and protein homeostatic regulatory mechanisms deteriorate.
There is a known relationship between extended wakefulness and
poorly consolidated sleep and an increase in cellular stress. In an aged
population, when sleep is chronically poor, and protein homeostatic
regulatory mechanisms are less efficient, the cell becomes inundated
with misfolded proteins leading loss of adaptive mechanisms and to in-
flammatory signaling. The work presented will explore the interplay be-
tween aging, sleep quality, and proteostasis and how these processes
are implicated in the development and progression of neurodegenera-
tive diseases like Alzheimer's disease. We also present data suggesting
that reducing cellular stress and improving proteostasis and sleep qual-
ity could serve as potential therapeutic solutions for the prevention or
delay in the progression of these diseases.
Methods: Xxxxxxxxxxxx.
Results: Xxxxxxxxxxxx.
Conclusions: Xxxxxxxxxxxx.
Disclosure: Nothing to disclose.
O116 | Impaired sleep slow-­wave oscillations in
Alzheimer's disease
M.A. Busche
UK Dementia Research Institute, University College London, London,
United Kingdom
It is increasingly clear that patients with Alzheimer's Disease (AD) ex-
hibit disordered sleep/wake patterns. While sleep impairments have
typically been thought of as sequelae of the underlying neurodegen-
erative processes, recent evidence indicates that sleep deficits may also
act as major candidate pathophysiological drivers of neurodegenera-
tion. By employing in vivo calcium imaging in mouse models of AD we
show that the accumulation of AD-­related Abeta peptides in the brain
is associated with a profound impairment of sleep-­related slow wave
oscillations. We further show that an alteration of excitatory/inhibitory
balance (E/I balance) underlies this oscillatory impairment, which is res-
cued by normalisation of the E/I balance. Furthermore, we find that
the impairment of slow wave oscillations is directly linked to memory
deficits in the mice. Altered sleep slow oscillations may therefore be a
novel and potentially reversible functional markers of AD and a modifi-
able target for early therapeutic intervention.
Disclosure: Nothing to disclose.
FRO M PATH O PH YS I O LO G Y TO TA RG E TE D
TR E ATM E NT O F OSA : C PA P A N D N E W
E M E RG I N G M O DA LITI E S ?
O117 | The multifaceted picture of OSA: can
pathophysiological, polysomnographic or clinical
characteristics guide treatment?
W.J. Randerath1; J. Vaz de Castro2; V. Koka3; A. de Vito 4
1
Bethanien Hospital/Institute for Pneumology at The University of
Cologne, Solingen, Germany; 2Sleep Medicine Center, CENC, Lisboa,
Portugal; 3Department of Sleep Medicine, Paris, France; 45ENT,
Ravenna Hospital, Ravenna, Italy
Over the last decades, the description of OSA, the classification
of its severity, and the initiation of treatment was based on the
apnoea-­hypopnoea-­index. However, important findings of recent
years pointed out that not only the obstruction of the upper air-
ways, but also muscle responsiveness, arousability from sleep, and
breathing regulation contribute to the pathophysiology. Moreover,
the AHI is only weakly associated with symptoms on the one hand
and cardiovascular outcome on the other. Although the idea of
a simple, one-­digit tool for the description of a disease is attrac-
tive, it does not describe the complexity of OSA. Therefore, new
concepts should be based on the analysis of the predominant
pathophysiological component to select the most effective thera-
peutical option, and treatment should be initiated based on the
synopsis of clinical symptoms and comorbidities. While physiolog-
ical studies are not useful for clinical practice, the precise analysis
of the polysomnographic data allows for sufficient analysis of ob-
struction, arousability and breathing regulation.
Disclosure: WR has Nothing to disclose in context of this Abstract.
However, WR reports grants and personal fees from Philips respiron-
ics, Heinen & Löwenstein, Resmed, Bayer Vital, Bioprojet, and Vanda
Pharma outside the submitted work.
O118 | Insides from evolving phenotyping
tools: emerging targeted non-­CPAP
therapies
V. Koka1; A. De Vito2; J. Vaz de Castro3; W. Randerath4
1
Sleep Medicine, Hospital Antoine Beclere, Clamart, France; 2ENT Unit,
Ravenna Hospital, Ravenna, Italy; 3CENC – Sleep Medicine Center,
Lisboa, Portugal; 4Sleep Medicine and Respiratory Care, Bethanien
Hospital, Solingen, Germany
Objectives/Introduction: Obstructive sleep apnea (OSA) is a multi-­
factorial disorder and four contributing phenotypes identified are
airway collapsibility, poor pharyngeal muscle responsiveness, a low
arousal threshold (AT) and a high loop gain (LG). We described the
ABSTRACTS
evolving phenotyping tools to identify these phenotypes to enable a
targeted treatment and discussed the perspective of pharmacother-
apy and orofacial myofunctional therapy (OMT) in OSA treatment.
Methods/Results: The CPAP dial ups and downs is a gold standard
procedure employed initially to identify the four key phenotypes.
Some individuals fully compensate during the 3-­min CPAP drops,
thus making difficult to calculate the LG.
A modified algorithm was proposed with gradual drops of 1-­cm of H2O
per minute until minimum tolerable ventilatory level and assessed V0
active at functional residual capacity by drops to atmospheric pressure.
Automated noninvasive estimate of ventilatory drive based on poly-
somnographic (PSG) ventilation and chemoreflex control model
made possible to identify OSA phenotypes from signals from stand-
ard PSG without requiring invasive gold standard techniques.
Breath holding for 20 seconds as a means to estimate LG and UA
collapsibility assessed by negative expiratory pressure while awake
were reported. Airflow shapes were analyzed to identify the site and
severity of pharyngeal obstruction.
Pharmacotherapy allows a new option for non-­
anatomical phe-
notypes. A combination of atomoxetine (noradrenergic) and oxy-
butynin (muscarinic antagonist) improved the genioglossus tone
three-­fold with AHI reduction by 63%. Eszopiclone increased AT by
30%, with 43% reduction AHI in patients with low AT.
Acetazolamide significantly reduced the LG by 41%. The presence of
higher LG, milder collapsibility and greater UA muscle compensation
were reported as the best predictors of success for oxygen therapy
in OSA.
Orofacial myofunctional therapy (OMT) offers a good perspective
in the treatment of OSA to increase the muscle tone of different
compartments of tongue and other pharyngeal and peripharyn-
geal muscles. A randomized control study with OMT revealed a re-
duction in neck circumference, snoring, daytime sleepiness, sleep
quality, and AHI.
Conclusions: The development of phenotyping tools is necessary to
identify OSA traits and choose a targeted treatment. There is a good
perspective for emergent non-­CPAP treatments employed alone or
in combined modality approach.
Disclosure: Nothing to disclose.
O119 | Rationale for CPAP treatment,
predictors of adherence and evaluation criteria of
success
J. Vaz de Castro1; V. Koka2; A. de Vito3; W. Randerath4
1 2
CENC – Sleep Medicine Center, Lisboa, Portugal; Sleep Medicine
Department, Hospital Antoine-­Béclère, Clamart, France; 3ENT
Department, Ravenna Hospital, Ravenna, Italy; 4Clinic for Pneumology
and Allergology, Centre for Sleep Medicine, Bethanien Hospital,
Solingen, Germany
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The concept of P4 medicine (prevention, prediction, personalization
and participation) has seeped into our daily practice and scientific
research. Increasing awareness on obstructive sleep apnoea (OSA)
phenotypes enables this transition, maintaining an individualized, but
evidence-­based treatment model. Albeit, continuous positive airway
pressure (CPAP) therapy, may be still viewed as a ‘one size fits all’ so-
lution and gold standard, as it opens the upper airway, regardless the
anatomical and/or physiological pathophysiology. Should CPAP still
be viewed as the saviour of OSA, or personalized? Notwithstanding
the benefits, elements of O4 medicine (overtesting, overdiagnosis,
overtreatment and overcharging) need to be considered as a counter
point. We aim to review CPAP treatment benefit, factors encom-
passing adherence and treatment success.
Results: Clinical, anatomical and polysomnographic phenotypes
have been identified, originating the following factors, integrated in
P4 and O4 medicine.
Prevention – Nutrition, exercise, sleep and OSA health literacy.
Prediction – Genetic and other risks for disease, planning for the ef-
fects of the illnesses in advance, through the presence of symptoms,
comorbidities, clinical questionnaires, polysomnography results.
Personalization – This where predictors of CPAP adherence shine,
focusing on the individual: Age, gender, insomnia, depression, hyper-
tension, rhinitis, medication, drug and alcohol consumption, educa-
tional, social and economic background. CPAP optimal pressures and
interface leakage. Management of comorbidities.
Participation -­OSA and CPAP education, interface choices, regular
follow up with counselling via telephone, telemedicine, pamphlets,
house calls and physician consultations.
Overtreatment – Asymptomatic with no comorbidities. Efficacy ver-
sus effectiveness in CPAP and non-­CPAP treatment.
Overcharging – The compound result of consultations, expensive
laboratorial tests, culminating in the life-­long CPAP treatment.
Conclusions: With the ongoing research into OSA phenotypes,
CPAP treatment indication can evolve, and reassert its’ place in mod-
ern age personalized medicine.
Disclosure: Nothing to disclose.
O120 | Reconsider the rationale for mandibular
advancement splits and surgical therapy:
individualized treatment from preselection to
multimodal concepts
A. De Vito1; V. Koka2; J. Vaz de Castro3; W. Randerath4,5
1
Head and Neck, ENT Unit, Ravenna Hospital, Romagna Health Service,
Ravenna, Italy; 2Sleep Medicine, Hospital Antoine Beclere, Clamart,
France; 3CENC – Sleep Medicine Center, Lisboa, Portugal; 4Clinic for
Pneumologie and Allergology, Bethanien Hospital; 5Center for Sleep
Medicine and Respiratory Care, Solingen, Germany
Introduction: First-­line therapy for obstructive sleep apnea (OSA)
includes positive airway pressure (PAP), but several other treatment
 |
60 of 356       ABSTRACTS
options have to consider: mandibular advancement devices (MAD),
upper airways (UA) surgery and hypoglossal nerve stimulation, posi-
tional therapy, weight loss, myofunctional therapy and drug therapy.
A multidisciplinary with multimodal approach for OSA treatment
represents the best clinical approach for OSA patients, with a pivotal
importance for achieving the best therapeutic outcome.
Results: Conventionally, multimodality approach in OSA treatment
is suggested for patients who fail or do not tolerate PAP therapy.
MAD is most appropriate for patients with mild or moderate OSA,
with demonstrated efficacy in significant reduction of obstructive
respiratory events and in improving daytime sleepiness. The ef-
ficacy of MAD is related to the stabilization of oropharyngeal and
hypopharyngeal areas.
Surgical treatment is indicated as a first line treatment for OSA when
the clinical selection showed a surgically correctible airway obstruc-
tion responsible for the obstructive respiratory events or predomi-
nant anatomical factor of UA collapse. Awake clinical examination
and drug-­
induced sleep endoscopic UA examination provide the
anatomical basis of surgical decision-­making, combined with a full
medical history and a careful polysomnographic analysis.
Surgical treatment for OSA provides long-­term benefits in appropri-
ately selected patients, although elimination of respiratory events
is often not completely achieved. Maxillomandibular advancement
is generally associated with an improvement in polysomnographic
parameters. However, it is a major procedure, and limited to patients
with persistent OSA following other surgical treatments or with
maxillary or mandibular hypoplasia.
Surgery can provide secondary line treatment for patients not ad-
equately adhering to PAP therapy or when patients struggle to use
PAP, due to obstructing anatomy. Likewise, MAD may provide an
improvement of surgical treatment effectiveness, stabilizing the hy-
popharyngeal level after a first surgical procedure at soft palate and
oropharyngeal levels.
Conclusions: An update of OSA treatment should plan multimodal-
ity treatments, which could achieve better therapeutic results than
single treatment option. This multimodality relation is mainly dem-
onstrated between PAP, MAD and UA surgery, overcoming ‘the one-­
fits all’ model, not currently acceptable in OSA clinical approach.
Disclosure: Nothing to disclose.
TA RG E TI N G S LE E P TO I M PROV E M E NTA L
H E A LTH
O121 | SLEEPexpert – a behavioral treatment
program for insomnia in patients with acute
psychiatric disorders
E. Hertenstein; C. Schneider; C. Nissen
Bern University, Bern, Switzerland
Insomnia is highly prevalent in patients with psychiatric disorders.
Having comorbid acute or chronic insomnia is associated with sig-
nificantly higher impairment compared to having a mental disorder
without insomnia. According to European guidelines, the gold stand-
ard treatment for patients with insomnia, including comorbid insom-
nia in patients with psychiatric disorders, is Cognitive Behavioral
Therapy for insomnia (CBT-­I). This treatment, however, is often not
used in patients with psychiatric disorders and insomnia – instead,
these patients are often treated pharmacologically, mostly with
benzodiazepines that have a high risk of tolerance, dependency and
cognitive side effects. One reason may be that CBT-­I is too com-
plex for severely ill patients with cognitive and motivational defi-
cits. The aim of ‘SleepExpert’ is to enable patients with psychiatric
disorders to improve their own sleep health. Sleep Expert is based
on CBT-­I and chronotherapy and comprises three steps: i) treatment
initiation by a psychologist or physician, ii) coaching by nurses, iii)
self-­management with the help of a web application. In her talk, Dr.
Hertenstein will present the results of the feasibility study and the
planned pilot RCT. The project has the potential to improve behavio-
ral treatment options for insomnia in patients with psychiatric disor-
ders and decrease the prescription of benzodiazepines.
Disclosure: Nothing to disclose.
O122 | Cognitive behavioural therapy for
insomnia in patients with concomitant anxiety
disorders
M. Jansson-Fröjmark
Karolinska Institute, Stockholm, Sweden
Insomnia disorder is often co-­occurring with anxiety disorders. Very
little is known concerning the efficacy of psychosocial treatments
for patients with insomnia disorder comorbid with anxiety disorders.
The presentation will focus on two studies. The aim was to examine
the efficacy of cognitive-­behavioural therapy for insomnia (CBT-­I)
for patients with insomnia disorder comorbid with generalised anxi-
ety disorder (GAD) in study I and with social anxiety disorder (SAD)
in study II.
In study I, an open trial design was used and included 24 pa-
tients with insomnia disorder and GAD. Study II is designed as a
randomised controlled trial, where CBT-­I is compared with a waitlist
control and will include 40 patients with insomnia disorder and SAD.
Due to the Covid-­19 pandemic, only nine patients have so far been
included in study II. In both studies, CBT-­I was administered face-­
to-­face across 10 weeks. In both studies, the patients completed
measures indexing insomnia, anxiety, worry, depression, functional
impairment, quality of life, treatment perception (credibility, expec-
tancy, and satisfaction), adverse events, and putative mechanisms.
Moderate to large effect sizes were observed for insomnia symp-
toms in both studies following CBT-­I. In terms of insomnia sever-
ity, approximately 61–66% of the patients responded to CBT-­I, and
ABSTRACTS
26–51% remitted. Moderate to large effect sizes were also demon-
strated for GAD and SAD symptoms, depression, functional impair-
ment, and quality of life. Approximately one-­third of the participants
reported an adverse event during CBT-­I. Five of the seven putative
mechanisms were significantly reversed in the expected direction,
i.e., all four cognitive process measures and time in bed.
The two studies imply that CBT-­I is an efficacious intervention
for patients with insomnia disorder comorbid with GAD and SAD.
The results highlight the need for further research using an RCT de-
sign with analyses of mechanisms of change and moderators.
Disclosure: Nothing to disclose.
H Y P OTH A L A M I C I N VO LV E M E NT I N S LE E P/
WA K E CO NTRO L
O123 | The role of melanin concentrating
hormone-­producing neurons in the regulation of
sleep and memory
A. Yamanaka1,2
1
RIEM, Neuroscience II, Nagoya University, Nagoya; 2JST CREST,
Kawaguchi, Japan
Melanin concentrating hormone (MCH)-­producing neurons are lo-
cated in the hypothalamus and projecting throughout the brain.
We previously showed that optogenetical activation of MCH neu-
rons enables convert non-­
rapid eye movement (NREM) sleep to
REM sleep. And ablation of MCH neurons decreased time in NREM
sleep and increased time in wakefulness. These results suggest that
MCH neurons are involved in the regulation of NREM and REM
sleep. Histochemical study revealed that MCH neurons densely in-
nervated the hippocampus where are implicated as memory center.
Thus, we tested memory ability of MCH neurons ablated mice and
found these mice significantly improved memory. Activation and
inhibition of MCH neurons using optogenetics or chemogenetics
impaired and improved memory, respectively. To reveal activity pat-
tern of MCH neurons across sleep/wakefulness state change, fiber
photometory was applied and found that MCH neurons were active
in the wakefulness and REM sleep. To further reveal the activity in
single cell level, miniature microscope calcium imaging in freely be-
having mice was applied and revealed that there are tree types of
MCH neurons, wake active, REM active, wake and REM active MCH
neurons. To reveal which type of MCH neurons are involved in the
memory impairment, MCH neurons were inhibited by optogenetics
with vigilance state dependent manner. REM sleep state dependent
inhibition improved memory suggested REM active MCH neurons
are involved in the impairment of memory. To further study the
mechanism of memory impairment, in vitro slice patch clamp record-
ing with optogenetical activation of MCH nerve terminals was per-
formed. Recording from pyramidal neurons in the hippocampus and
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activation of MCH nerve terminals in the hippocampus significantly
inhibited activity of pyramidal neurons with increase in inhibitory in-
puts. These results suggested that REM sleep-­active MCH neurons
erase or inhibit hippocampus-­dependent memory.
Disclosure: Nothing to disclose.
S O M E TH I N G N E W U N D E R TH E S U N :
M E TA B O LI C DYS FU N C TI O N I N OSA
O124 | Microbiome and OSA
R. Farre
University of Barcelona, Barcelona, Spain
The gut microbiota is a complex microbial ecosystem in symbiotic
association with the host. Whereas it was formerly thought to just
contribute to the digestion of some components of the host diet,
research in the last years has clearly shown that the gut microbiota
has a much complex interaction with the host physiological system
being considered as an ‘organ’ of the host. Hence, disbalance of gut
microbiota composition and function, known as dysbiosis, impacts
on host diseases and in turn host pathophysiology also modulates
the microbiota ecosystem. In particular, the gut microbiota plays an
important role in host immunologic response and modulates host
diseases such as obesity, coronary heart disease, hypertension or
depression. Regarding obstructive sleep apnea (OSA), research in
both animal models and humans has provided solid evidence that the
microbiota is involved in OSA development and in its consequences.
Indeed, both intermittent hypoxia and sleep fragmentation, the two
main hallmarks of OSA, modify the gut microbiota ecosystem poten-
tially contributing to the short-­and long-­term consequences of this
sleep breathing disorder. Current research is now trying to discover
the mechanisms involved in the gut microbiota-­host crosstalk for
better understanding OSA pathophysiology and for discovering po-
tential treatments for mitigation the metabolic, cardiovascular and
neurocognitive consequences of OSA.
Disclosure: Nothing to disclose.
O125 | Cerebral metabolism and OSA
C. Liguori
Sleep Medicine Centre, Department of Systems Medicine, University of
Rome Tor Vergata, Rome, Italy
Obstructive sleep apnea (OSA) is the most frequent sleep-­
disordered breathing and is presenting an increasingly common
prevalence in the adult and elderly populations. It has been already
established that OSA represents a risk factor for several morbidities;
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62 of 356       ABSTRACTS
furthermore, it has been recently documented that OSA may also
promote neurodegenerative processes, by intermittent hypoxia and
sleep fragmentation, which are two established mechanisms altering
brain health. Cerebral glucose metabolism can be in vivo studied by
using nuclear medicine instruments (such as positron emission to-
mography – PET) and cerebrospinal-­fluid measurements of pyruvate
and lactate (the biomarkers quantifying the efficiency of mitochon-
drial activity). However, studies evaluating brain 18F-­FDG PET in
patients with OSA are very rare and did not consider the possible
effects of longitudinal (more than 3 months) continuous positive air-
way pressure (CPAP) treatment. Notably, they documented the al-
teration of cerebral glucose metabolism in patients with OSA, which
is not restored by 3-­months CPAP treatment. Moreover, CSF studies
in patients with OSA are few and showed the increase of lactate lev-
els in patients with OSA, as a possibly result of mitochondrial impair-
ment or dysregulation. In this presentation, studies about cerebral
glucose metabolism in patients with OSA will be presented, also in
relation with biomarkers of neurodegeneration or sleep architecture
changes and oxygen saturation parameters alteration.
Disclosure: Nothing to disclose.
O126 | Carotid body, intermittent hypoxia and
metabolism
J.F. Sacramento1; B.F. Melo1; E. Olea2; A. Obeso3; A.
Rocher3; T. Rodrigues4; J. Prieto-Lloret3; S. Yubero3; E.C.
Monteiro1; P. Matafome5; S.V. Conde1
1
CEDOC, NOVA Medical School, Faculdade de Ciências Médicas,
Universidade Nova de Lisboa, Lisbon, Portugal; 2Department of
Nursing, University of Valladolid, School of Nursing, Valladolid, Spain
and Institute of Molecular Biology and Genetics, CIBER Enfermedades
3
Respiratorias, CIBERES, Institute of Salud Carlos III; Department
of Biochemistry and Molecular Biology and Physiology, University
of Valladolid, School of Medicine, Valladolid, Spain; 4Institute of
Physiology and Institute of Clinical and Biomedical Research (iCBR),
Faculty of Medicine, University of Coimbra; 5Institute of Physiology
and Institute of Clinical and Biomedical Research (iCBR), Faculty of
Medicine, University of Coimbra and Instituto Politécnico de Coimbra,
Coimbra Health School, Coimbra, Portugal
The carotid bodies (CB) are arterial chemoreceptors that classically
sense and respond to changes in arterial blood O2, CO2 and pH lev-
els. Besides its role in the control of ventilation, the CB have been
described as metabolic sensors involved in energy homeostasis. In
obstructive sleep apnea (OSA), it has been suggested that CB medi-
ate the reflex increase in sympathetic activity and blood pressure due
to chronic intermittent hypoxia (CIH) (Narkiewicz et al. Circulation.
99:1183–1189, 1999). In the last years, our group have described
that the CB is primordial in controlling peripheral insulin sensitivity
and that CB dysfunction is involved via sympathetic overactivation
in the genesis of insulin resistance and glucose tolerance (Conde
et al. Physiol. Genomics. 50:208–214, 2018; Ribeiro et al. Diabetes.
62:2905–16, 2013), two pathological features that are also associ-
ated with OSA. Additionally, the CB has already been proposed as
one of the links between CIH, sympathetic activity and metabolic
dysfunction (Conde et al. Front. Physiol. 5:418, 2014). Our group de-
scribed that the effect of chronic intermittent moderate hypoxia on
insulin sensitivity and signaling is time-­dependent (Sacramento et al.
Respir. Physiol. Neurobiol. 228:30–38, 2016). Moreover, this effect
was associated with alterations in the hypoxia-­
inducible factors
(HIF) signaling in the liver and skeletal muscle. Recently, and aiming
to understand the main contributor to the development of insulin
resistance in CIH, rats were exposed during 35 days to a moderate
CIH or 15 days to a severe CIH protocol. Both groups exhibit insulin
resistance without alterations in fasting glycaemia, effects that were
associated with a pancreatic b-­cell dysfunction and an increase in
insulin secretion. Additionally, and since adipose tissue inflammation
as been pointed put as one of the major contributors to CIH-­induced
metabolic deregulation we aimed to clarify the contribution of this
tissue to the development of insulin resistance in CIH. The study of
the mechanisms behind the development of insulin resistance in CIH
will contribute to better understand the paradigm of CIH-­induced
insulin resistance and therefore, the relationship between OSA and
CB and metabolic dysfunction.
Supported by: PTDC/SAU-­
TOX/112264/2009, Pest-­
C/
SAU/UI3282/2011. JFS by PD/BD/105890/2014. BFM by PD/
BD/128336/2017.
Disclosure: Nothing to disclose.
O127 | Hyperlipidaemia and OSA
O.K. Basoglu
Chest Diseases, Ege University Faculty of Medicine, Izmir, Turkey
Obstructive sleep apnoea (OSA) is a highly prevalent disorder char-
acterized by repeated upper airway obstructions during sleep, lead-
ing to intermittent hypoxaemia, sympathetic excitation, and sleep
fragmentation. Sleep apnoea patients are more likely to develop
cardiovascular and metabolic disorders, in particular systemic hy-
pertension, heart failure, coronary heart disease, stroke, diabetes
mellitus, insulin resistance and also hyperlipidaemia.
Dyslipidaemia, defined as abnormally elevated total cholesterol
(TC) or triglycerides (TG) with or without a corresponding signifi-
cantly reduced high density lipoprotein (HDL) level, is associated
with progressive atherosclerosis. The role of OSA in the develop-
ment of dyslipidaemia has been investigated in animal models and
clinical studies for evaluation of independent relationship beyond
the effects of obesity. Sleep fragmentation and chronic intermittent
hypoxia (CIH) in OSA cause activation of the sympathetic nervous
system, increased oxidative stress and systemic inflammation, mech-
anisms that may promote dyslipidaemia. Evidence from animal mod-
els of OSA has shown that CIH induces fasting dyslipidaemia in both
ABSTRACTS
lean and obese mice. Similarly, OSA was independently associated
with hyperlipidaemia diagnosis, and the link was particularly strong
with intermittent hypoxia, and an independent relationship be-
tween OSA severity and lipid concentrations which was influenced
by central obesity was also demonstrated in the large multicentre
European Sleep Apnoea Database (ESADA) cohort. A meta-­analysis
analysed 18,116 patients showed that OSA is associated with higher
TC, TG and LDL concentrations, and lower HDL; with a correlation
between apnoea-­hypopnea index and lower HDL and higher TG
concentrations. Dyslipidaemia may be the mechanism of atheroscle-
rosis in OSA patients.
Continuous positive airway pressure (CPAP) can improve dyslip-
idaemia and reduce cardiovascular morbidities in OSA. In a meta-­
analysis, independent benefits of CPAP on lipid profiles, including TC
and TG-­lowering effects, were confirmed especially in patients with
moderate-­to-­severe OSA, daytime sleepiness, good compliance to
CPAP, or short-­duration CPAP treatment. However, most controlled
studies were small and of short duration and potentially not fully
controlling confounding factors on top of PAP treatment.
In conclusion, OSA patients frequently exhibit higher rates of in-
termittent hypoxia induced dyslipidaemia, a risk factor for cardiovas-
cular and cerebrovascular disorders, and CPAP therapy can prevent
these comorbidities.
Disclosure: Nothing to disclose.
A S E N S ITI V E S YS TE M U N D E R FI R E ?
I D E NTI F Y I N G S LE E P -­W A K E- ­R EG U L ATO RY
R I S K FAC TO R S FO R TH E D E V E LO PM E NT
O F M E NTA L D I S O R D E R S D U R I N G
A D O LE S C E N C E
O128 | Circadian light sensitivity of
adolescents
S. Crowley
Department of Psychiatry & Behavioral Sciences, Rush University
Medical Center, Chicago, IL, United States
Adolescence is associated with a delay in sleep onset and chronic
insufficient sleep. Changes to sleep regulatory systems partly con-
tribute to late sleep onset during adolescence; modeling work sug-
gests that sleep propensity accumulation during waking slows and
the central circadian clock delays in older post-­pubertal adolescents
compared to younger pre-­pubertal adolescents. Such changes favor
alertness in the evening, making it more difficult for older adoles-
cents to fall asleep early. It has been hypothesized that changes to
light sensitivity may drive the circadian delay seen in older adoles-
cents. In comparison to younger adolescents, older adolescents are
predicted to have a greater circadian response to evening (phase
delaying) light, an attenuated circadian response to morning (phase
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advancing) light, or both. We tested these hypotheses in two stud-
ies. The first study examined melatonin suppression in response
to white light exposure in the evening or morning in pre-­to mid-­
pubertal adolescents and late to post-­pubertal adolescents. The
second study measured circadian phase shifts in response to bright
white light (~5000 lux; 80 mins) starting at different times across
the day in post-­pubertal adolescents aged 14–17 years to create a
phase response curve to light. Results of both studies suggest that
altered circadian photosensitivity does not appear to explain the cir-
cadian phase delay of late adolescence. Our recent work posits that
the central circadian clock's ability to reset to an earlier time (phase
advance) may be modulated by typical adolescent sleep patterns and
associated exposures: evening light exposure by staying awake late
and/or chronic insufficient sleep due to early school schedules. In a
preliminary study, we examined phase shifts to bright morning light
when sleep was restricted to 5.5 h by delaying bedtimes or sleep
was satiated (10 h). As expected, participants in the 10-­h sleep group
advanced by ~2 h. Adolescents who stayed awake later in room light
and were restricted to 5.5 h of sleep did not shift or shifted in the
opposite direction (delayed 2–4 h). These data have implications for
treating phase delayed adolescents with morning bright light. The
mechanisms by which this occurs is currently being studied in our
laboratory.
Disclosure: Nothing to disclose.
O129 | Caffeine effects on sleep-­wake
regulation during adolescence
C.F. Reichert1,2; S. Veitz1,2; M. Bühler1,2; G. Gruber3; S.
Rehm4; K. Rentsch4; C. Garbazza1,2; M. Meyer5; H. Slawik5;
Y.-S. Lin1,2,6; J. Weibel1,2
1
Center for Chronobiology, University of Basel; 2Transfaculty Research
Platform Molecular and Cognitive Neurosciences, University of Basel,
Basel, Switzerland; 3The Siesta Group Schlafanalyse GmbH, Vienna,
Austria; 4Laboratory Medicine, University of Basel; 5Clinical Sleep
Laboratory; 6Neuropsychiatry and Brain Imaging, Psychiatric Hospital
of the University of Basel, Basel, Switzerland
Adolescents often suffer from short and mistimed sleep. To coun-
teract the resulting daytime sleepiness they frequently consume
caffeine. However, in adults, caffeine can disturb sleep and delay
circadian timing, and therefore may intensify sleep problems in teen-
agers. In our randomized double-­blind crossover study, we adminis-
tered 80 mg of caffeine (vs placebo) four hours before bedtime to 18
teenagers (14–17 years old, mean habitual caffeine intake 248 mg/
week), after a 1-­
week ambulatory phase of caffeine abstinence.
Salivary caffeine levels peaked within one hour after administration
and remained high until bedtime. In the caffeine condition, partici-
pants felt less sleepy, had fewer attentional lapses, but also reported
more problems to fall asleep compared to placebo. Furthermore, PSG-­
analyses indicate a reduced sleep efficiency, a higher percentage of
 |
64 of 356       ABSTRACTS
N1 and a lower percentage of N3 after caffeine compared to placebo
intake. This caffeine-­induced reduction of N3 percentage strongly
varied between individuals, and was stronger in participants with a
higher percentage of N3 during the placebo night. Finally, the spec-
tral analysis of the EEG-­data indicate a reduced delta (0.75–4.5 Hz)
power density during NREM sleep in the first 1.5 hours of sleep after
caffeine compared to placebo intake. Regarding circadian timing, a
delay in melatonin onset was surprisingly not evident at the group
level, and only observed in participants exposed to a higher caffeine
dose relative to the individual bodyweight (i.e., a dose >1.3 mg/kg).
Taken together, the data suggest that evening intake of 80 mg of
caffeine (i.e., the content of 250 ml of common energy drinks) can
be sufficient to promote alertness and disturb sleep. Future studies
might focus on endogenous and exogenous factors explaining the
differential vulnerability and variance in these acute effects of caf-
feine, which we observed apart from differences in group means.
The currently available evidence does not allow to conclude whether
such sleep disturbances might persist under conditions of chronic
intake or whether the adolescent brain can adapt to a continuous
supply of the stimulant. In either case, caffeine should be consumed
with caution.
Disclosure: Funding: Swiss National Science Foundation (SNSF)
PMPDP1_171364.
O130 | Sleep and circadian effects on
reward sensitivity and impulse control during
adolescence
B. Hasler
Center for Sleep and Circadian Science, University of Pittsburgh School
of Medicine, Pittsburgh, PA, United States
Sleep and circadian timing shift later during adolescence, exacer-
bated by evening light exposure from electronic devices, conflict-
ing with early school and work schedules, and resulting in circadian
misalignment and insufficient sleep. These sleep and circadian dis-
turbances have been associated with affective dysregulation and
substance use, with emerging evidence suggesting that altered re-
ward function and impaired impulse control may have mechanistic
roles. Our program of research examines whether circadian mis-
alignment alters reward function and impairs impulse control during
adolescence, thereby increasing risks for affective and substance
use disorders.
Data will be presented from two prior studies and one ongoing
study, all employing objective measures of sleep (actigraphy), circa-
dian rhythms (dim light melatonin onset, DLMO), and neuroimaging
(fMRI). Study 1 used a counterbalanced cross-­over design in healthy
13–17 year-­olds to test the effect of experimentally-­imposed circa-
dian misalignment on the neural response to monetary reward and
response inhibition. Study 2 examined the association between cir-
cadian alignment (based on the DLMO-­midsleep phase angle) and
reward-­
related brain function in 18 to 22-­
year-­
old alcohol users.
Study 3 is using a therapeutic manipulation to advance circadian
phase and extend sleep in high school students with late sleep timing,
testing whether this improves reward function and impulse control.
Results from Study 1 suggest a reduced neural response to
monetary reward and during response inhibition in misaligned ver-
sus aligned conditions. Results from Study 2 suggest that circadian
misalignment, based on a smaller DLMO-­midsleep phase angle, is
associated with a lower neural response to monetary reward the fol-
lowing day. Preliminary results from Study 3 suggest that correcting
circadian misalignment by advancing circadian phase and extending
sleep is associated with altered activation across canonical brain
networks during monetary reward and stop signal tasks.
As a whole, our findings suggest that circadian misalignment
experienced by adolescents, particularly during the school year, im-
pacts neural activity associated with reward function and impulse
control. Ongoing and future studies will test whether (1) sleep/cir-
cadian effects on reward and impulse control account for increased
risk for affective and substance use disorders, and (2) whether pre-
venting and/or treating sleep/circadian disturbances reduces risk for
affective and substance use disorders.
Disclosure: Nothing to disclose.
O131 | Inter-­individual differences in sleep:
implications for adolescent mental health
L. Tarokh
University Hospital of Child and Adolescent Psychiatry and
Psychotherapy, University of Bern, Bern, Switzerland
The sleep EEG provides an opportunity to measure the brains electrical
activity during sleep. During adolescence sleep EEG oscillatory activ-
ity undergoes marked changes. Among these changes is a reduction in
sleep EEG power coupled with an increase in sleep EEG coherence. Two
oscillations of interest, slow wave activity and sleep spindles, generated
through cortico-­cortical and thalamo-­cortical loops respectively, are a
unique marker of the activity of these networks in-­vivo. Considerable
inter-­individual variability exists in the strength of these oscillations.
Given the neurobiological origins of these oscillations, inter-­individual
differences may be of functional significance. Using a behavioral ge-
netics approach we estimate the degree to which genetic and environ-
mental factors contribute to slow wave activity and sleep spindles. I
will present data showing that both genetic and environmental factors
influence sleep EEG oscillatory activity dependent on brain region and
frequency. I will then present data showing the associations between
sleep EEG oscillations and indices of mental health. Data from two co-
horts will be presented: a non-­clinical cohort in which the association
between sleep and depressive symptoms is examined and a clinical co-
hort examining sleep in individuals with childhood onset schizophrenia.
We find diminished spindles, albeit to varying degrees, in both cohorts
suggesting that changes in sleep EEG oscillatory activity may not be
ABSTRACTS
disorder specific. I will then present a transdiagnostic and dimensional
view of the association between sleep and mental health in adoles-
cence and our approach to testing the predictive value of sleep EEG
oscillatory activity.
Disclosure: Nothing to disclose.
PH OS PH O RY L ATI O N H Y P OTH E S I S O F
S LE E P
O132 | Systems biology of mammalian sleep/
wake cycles – phosphorylation hypothesis of sleep
1,2,3
H.R. Ueda
1
WPI-­IRCN, UTIAS, The University of Tokyo; 2Systems Pharmacology,
Graduate School of Medicine, University of Tokyo, Tokyo; 3Laboratory
for Synthetic Biology, Center for Biosystems Dynamics Research,
RIKEN, Suita, Japan
The detailed molecular and cellular mechanisms underlying NREM
sleep (slow-­
wave sleep) and REM sleep (paradoxical sleep) in
mammals are still elusive. To address these challenges, we first
constructed a mathematical model, Averaged Neuron Model (AN
Model), which recapitulates the electrophysiological characteris-
tics of the slow-­wave sleep. Comprehensive bifurcation analysis
predicted that a Ca2+-­d ependent hyperpolarization pathway may
play a role in slow-­wave sleep. To experimentally validate this
prediction, we generate and analyze 26 KO mice, and found that
impaired Ca2+-­d ependent K+ channels (Kcnn2 and Kcnn3), voltage-­
gated Ca2+ channels (Cacna1g and Cacna1h), or Ca2+/calmodulin-­
dependent kinases (Camk2a and Camk2b) decrease sleep duration,
2+
while impaired plasma membrane Ca ATPase (Atp2b3) increases
sleep duration. Genetical (Nr3a) and pharmacological intervention
(PCP, MK-­8 01 for Nr1/Nr2b) and whole-­b rain imaging validated
that impaired NMDA receptors reduce sleep duration and directly
increase the excitability of cells. Based on these results, we pro-
pose phoshporylation hypothesis of sleep that phosphorylation-­
dependent regulation of Ca2+-­d ependent hyperpolarization
pathway underlies the regulation of sleep duration in mammals.
We also recently developed a simplified mathematical model,
Simplified Averaged Neuron Model (SAN Model), which uncover
the important role of K+ leak channels in NREM sleep. In this talk,
I will also describe how we identify essential genes (Chrm1 and
Chrm3) in REM sleep regulation, and propose a plausible molecular
definition of a paradoxical state of REM sleep.
References:
1. Tatsuki et al. Neuron, 90(1): 70–85 (2016).
2. Sunagawa et al, Cell Reports, 14(3):662–77 (2016).
3. Susaki et al. Cell, 157(3): 726–39 (2014).
4. Tainaka et al. Cell, 159(6):911–24(2014).
5. Susaki et al. Nature Protocols, 10(11):1709–27(2015).
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6. Susaki and Ueda. Cell Chemical Biology, 23(1):137–57 (2016).
7. Ode et al. Mol. Cell, 65, 176–190 (2017).
8. Tatsuki et al, Neurosci. Res. 118, 48–55 (2017).
9. Ode et al, Curr. Opin. Neurobiol. 44, 212–221 (2017).
10. Susaki et al, NPJ. Syst. Biol. Appl. 3, 15 (2017).
11. Shinohara et al, Mol. Cell 67, 783–798 (2017).
12. Ukai et al, Nat. Protoc.12, 2513–2530 (2017).
13. Shi and Ueda. BioEssays 40, 1700105 (2018).
14. Yoshida et al, PNAS 115, E9459-­E9468 (2018).
15. Niwa et al, Cell report, 24, 2231–2247. e7 (2018).
Disclosure: Nothing to disclose.
K E Y N OTE LEC T U R E – D. G OZ A L , U S
O133 | Circulating exosomes and morbidity of
obstructive sleep apnea: effectors, biomarkers,
both?
D. Gozal
Department of Child Health and Child Health Research Institute,
University of Missouri School of Medicine, Columbia, MO, United
States
Intercellular communication is an essential hallmark of multicel-
lular organisms and is mediated through direct cell-­cell contact or
through specialized and highly regulated transfer of secreted vesi-
cles. Exosomes are extracellular nano-­vesicles, 30–120 nm in size,
that are released into the extracellular space by reverse budding
of multi-­vesicular bodies containing intraluminal vesicles that can
bind to the plasma membrane of the acceptor cell and be internal-
ized through either endocytosis or micropinocytosis. Exosomes
have a very diverse cargo that includes proteins, lipids, and most
importantly a large variety of genomic material, especially miRNAs.
Exosomes participate in a vast array of physiological processes such
as cell metabolism, proliferation and differentiation, and can be iso-
lated from all body fluids. It is estimated that ~4 billion exosomes are
produced and released daily into the various extracellular compart-
ments in humans.
Obstructive sleep apnea (OSA) is a very frequent disorder that
has been associated with increased risk of cardiovascular, metabolic,
and cognitive and mood dysfunction, as well as with enhanced can-
cer prevalence and mortality. However, at any level of OSA severity
there will be patients who exhibit a particular morbidity and other
who do not, thereby prompting the need for more personalized ap-
proaches to delineate optimal diagnostics and treatment.
Recent evidence that indicates that exosomes generated and
released by specific cell lineages can either foster protection or
facilitate damage to target cells and organs in the context of the
hypoxia-­re-­oxygenation or arousal events that characterize OSA.
Furthermore, exosomes shed by specific cells have been implicated
 |
66 of 356       ABSTRACTS
in processes involved in atherosclerosis, cardiovascular diseases, di-
abetes, and cancer biological pathways. In this presentation, I will
review some of our recent work which explores the heterogeneity
of end-­organ dysfunction in patients with OSA, provide insights on
exosomes and their function, and how exosomal cargo can mediate
specific OSA-­associated phenotypes. In addition, I will also illustrate
potential biomarker and therapeutic opportunities involving OSA
and exosomes. There is little doubt that the venues that will lead us
to precision medicine in sleep disorders will need to incorporate an
improved understanding of exosomal biology.
Disclosure: Supported by National Institutes of Health grants
HL130984 and HL140548.
K E Y N OTE LEC T U R E – L . D E LEC E A , U S
O134 | Optogenetic control of arousal state
transitions
L. de Lecea
Department of Psychiatry and Behavioral Sciences, Stanford University,
Stanford, CA, United States
The arousal construct underlies a spectrum of behaviors that in-
clude sleep, exploration, feeding, sexual activity and adaptive stress.
Pathological arousal conditions include stress, anxiety disorders, and
addiction. In the past few years we have used optogenetics to in-
terrogate neuronal circuits underlying transitions between arousal
states. In particular, I will talk about how the hypocretin system,
makes the decisions about when to mark the transition between
sleep and wakefulness. The dynamics between arousal state tran-
sitions are also modulated by norepinephrine neurons in the locus
coeruleus, histaminergic neurons in the hypothalamus, dopaminergic
neurons in the mesencephalon and cholinergic neurons in the basal
forebrain. I will talk about an attempt to model sleep/wake dynamics
using probabilistic estimates of neurotransmitter function based on
optogenetic stimulations. Examples of dysfunctional arousal circuits
in the aging brain will also be presented and discussed.
Disclosure: Nothing to disclose.
H I D I N G I N PL A I N S I G HT: S LE E P,
N EU RO D E V E LO PM E NT, A N D PE D I ATR I C
M E NTA L H E A LTH
O135 | The epidemiology of sleep and pediatric
psychopathology: findings from the generation R
study
M.E. Koopman-Verhoeff
Erasmus Medical Center – GenerationR, Child and Adolescent
Psychiatry, Erasmus MC University Medical Center, Rotterdam, The
Netherlands
This presentation discusses the epidemiology of sleep and mental
health in the general pediatric population. We will do this by focus-
ing on (i) determinants of sleep problems, (ii) longitudinal associa-
tions of sleep and mental health in children, and (iii) self-­medication
of sleep problems in healthy children and children with develop-
mental psychopathology. To answer these questions, we included
data from the Generation R Study, a prospective population-­based
cohort from fetal life onward in a multi-­ethnic urban population in
the Netherlands. This cohort includes unique longitudinal data with
subjective and actigraphic sleep information as well as child mental
health reports obtained from parents and children. Subjective data
includes sleep problems as reported by around 5000 mothers and
children tapping on experiences of dyssomnia, parasomnia symp-
toms, and perceived sleep quality. In a subsample of 1486 children
and adolescents, actigraphic measures of sleep were available as
estimated by the combination of actigraphy and sleep diaries that
the children completed for 9 days in a row in regular school-­weeks
(including five schooldays and 4 weekend days). In this session we
will highlight our findings and discuss them in the context of current
epidemiological studies. Lastly, we will propose future directions for
the field.
Disclosure: Nothing to disclose.
O136 | Sleep and the ADHD brain in children:
dysregulated, vulnerable, inattentive
J. Saletin1; M.E. Koopman-Verhoeff2; D. Dickstein1; M.
Carskadon1
1
Psychiatry and Human Behavior, Alpert Medical School of Brown
University, Providence, RI, United States; 2Erasmus MC University
Medical Center, Rotterdam, The Netherlands
Introduction: Attention-­deficit-­hyperactivity-­disorder (ADHD) is a
common disorder of childhood and associated with sleep dysregula-
tion. How sleep patterns are expressed in ADHD, and how ADHD
ABSTRACTS
and sleep interact to moderate inattention, impulsivity and associ-
ated brain outcomes is unknown.
Objectives: Here, we present preliminary evidence highlighting the
neural vulnerability of those with ADHD to sleep-­loss.
Aims: This symposium will present data from four distinct sources.
Methods: (1) A published laboratory study of overnight memory con-
solidation in 21 children (7 with ADHD) investigated how sleep benefits
cognition in this disorder; (2) An ALE meta-­analysis of 134 fMRI arti-
cles investigated whether ADHD and sleep-­loss share common neural
effects; (3) A pilot study of 12 weeks of actigraphy in 13 children (8F;
12.6 ± 0.7 y) investigated how sleep patterns are expressed across
ADHD symptoms; and (4) An ongoing study of acute-­sleep loss on sleep
EEG and functional MRI outcomes of inhibition and resting state connec-
tivity) in children ages 10–13 across a range of ADHD symptom severity.
Results: (1) Children with ADHD had diminished EEG sleep spin-
dle activity (power in Stage 2; 12–13.5 Hz) compared to typically
developing controls (t(19) = −2.48; p = 0.023; d = −1.15); the same
EEG power was associated with memory improvement (b = 8.71;
p < 0.001) in the ADHD group alone. (2) Our meta-­analysis revealed
that ADHD and experimental sleep-­loss share reductions in activa-
tion within inhibitory-­control networks: dorsal anterior cingulate
(dACC) and middle/inferior frontal (M/IFG) cortices (p < 0.005;
k = 20 mm). (3) Hyperactivity-­symptoms were associated with irreg-
ular sleep patterns (b = −0.0025; p = 0.032). (4) Following 5.5 hours
of wake extension those with higher hyperactivity experienced
greater reductions in inhibition-­related activation in the aforemen-
tioned dACC (p < 0.005; k = 20 mm), together with greater reduc-
tions in resting default-­mode connectivity (r = −0.69; p = 0.008).
Conclusions: These results support a new appreciation for sleep in
ADHD. First, sleep physiology may support healthy cognitive brain
function in these children. Second, ADHD and sleep-­loss share com-
mon reductions in inhibition-­related brain activation. Third, ADHD-­
symptoms index greater dysregulation of sleep across 12-­weeks of
monitoring. Finally, more severe symptoms were associated with
vulnerability to sleep loss. Ultimately, more focus is needed on sup-
porting sleep in children with ADHD to mitigate these effects.
Disclosure: Research supported by K01MH109854 (to JMS); Rhode
Island Foundation Medical Research Grant (to JMS).
O137 | Age-­associated variation in brain
maturation: relationships with sleep and mood
symptoms across adolescent development
A. Soehner1; P. Franzen2; B. Hasler2; D. Buysse2; M.
Jalbrzikowski2
1
University of Pittsburgh School of Medicine; 2Psychiatry, University of
Pittsburgh School of Medicine, Pittsburgh, PA, United States
Introduction: Mounting evidence indicates that sleep disruption and
aberrations in brain maturation contribute to the onset depression.
However, it is unclear how these two risk processes are related.
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Aim: Our goal was to test whether age-­specific deviations from norma-
tive gray matter maturation were associated with sleep behavior and
depressive symptoms during adolescent development (ages 9–23 years).
Methods: Two open-­access neuroimaging cohorts (Pediatric Imaging,
Neurocognition, and Genetics, PING, N = 362, 9–22 y; Philadelphia
Neurodevelopmental Cohort, PNC, N = 582, 9–23 y) were combined
to characterize age-­associated changes in gray matter structures
(cortical thickness and surface area; subcortical volumes). In paral-
lel, we constructed a large harmonized cohort from multiple studies
of typically developing adolescents conducted at the University of
Pittsburgh (PITT) with anatomical neuroimaging, sleep actigraphy,
and depression symptom measures. Analyses were conducted in
the initial harmonized PITT sample (N  = 114, 9–23 yr; 4 out of 11
protocols). In the PITT sample, we calculated age-­associated de-
viations in gray matter structures using PING/PNC as a normative
reference. Actigraphic sleep outcomes derived in PITT were sleep
duration, timing (midsleep), regularity (midsleep variability), and con-
tinuity (wake after sleep onset; WASO). A subset of the PITT sample
(N = 72) completed age-­appropriate depressive symptom measures,
which were harmonized to the PROMIS-­Depression Scale T-­Score.
Results: Elastic net regression identified correlations between longer
sleep duration and greater age-­associated deviation in right frontal pole
and left fusiform cortical thickness (R2 = 0.14, p < 0.00002). Greater
midsleep variability was associated with greater age-­related deviation
in left precentral gyrus cortical thickness and left parahippocampal sur-
face area (R2 = 0.05, p < 0.009). We did not detect associations between
gray matter outcomes and midsleep or WASO. Elastic net models also
identified correlations between higher depressive symptom severity
and greater age-­associated deviation in subcortical volumes (left hip-
pocampus, right nucleus accumbens) and an extensive set of fronto-­
temporo-­parietal regions, a subset of which were linked to sleep (e.g.,
left parahippocampal surface area, right frontal pole cortical thickness).
Conclusion: These findings suggest that age-­appropriate gray mat-
ter maturation is tied to more optimal sleep and euthymic mood.
Deviation from normative brain maturational trajectories in specific
regions may be one neural substrate linking sleep behaviors to the
development of depression.
Disclosure: Nothing to disclose.
S LE E P A N D PL A S TI C IT Y: H Y P OTH E S E S A N D
EVIDENCE
O138 | Effects of motor learning, sleep, and
sleep deprivation on cortical synapses
C. Cirelli1; D. Miyamoto2; W. Marshall2; G. Tononi2
1
Psychiatry; 2U. Wisconsin-­Madison, Madison, WI, United States
The mechanisms by which sleep benefits learning and mem-
ory remain unclear. Sleep may further strengthen the synapses
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68 of 356       ABSTRACTS

potentiated by learning or promote broad synaptic weakening that
spares the newly potentiated synapses. We recently tested these
ideas by combining a motor task whose consolidation is sleep-­
dependent (the complex wheel task), a marker of synaptic AMPA re-
ceptor plasticity (the GluA1 subunit of the AMPA receptors tagged
with Super Ecliptic pHluorin, SEP-­GluA1), and repeated two-­photon
imaging to track hundreds of spines in vivo with single spine resolu-
tion. In mouse motor cortex, the overall effect of sleep was a net
decrease in synaptic GluA1-­containing AMPA receptors, both before
and after learning. Molecular changes in single spines during post-­
learning sleep were correlated with changes in performance after
sleep. Compared to all remaining spines, those most potentiated by
learning weakened during post-­learning sleep, but less so than after
sleep deprivation, consistent with sleep affording relative protec-
tion. These results were obtained in adult mice, showing that sleep-­
dependent synaptic down-­selection also benefits the mature brain.
Supported by NIH grants DP 1OD579 (GT), 1R01MH091326
(GT), 1R01MH099231 (GT, CC), 1P01NS083514 (GT,
Department of Defense W911NF1910280 (CC, GT), Human Frontier
HFSP long-­
term fellowship LT000009/2017 and Japan-­
US Brain
Research Cooperation Program grant (DM).
Disclosure: Nothing to disclose.
circuits and synapses for further processing (i.e. synaptic weakening
and strengthening consolidation) in sleep. During sleep, network re-
activation during NREM sleep and protein synthesis at tagged syn-
apses during REM sleep leads to structural changes necessary for
long-­term information storage.
To support the theory, I will provide evidence from molecular and
imaging data from different studies, including ours, focusing mainly
on changes in the cortex, the site of long-­term storage of informa-
tion. I will also discuss the predictions and caveats of the theory.
Disclosure: Nothing to disclose.
O140 | Phosphoproteomics of experience-­
dependent changes during slow-­wave sleep and
REM sleep: differences between hippocampus
and primary somatosensory cortex of rats
CC),
D. Golbert1; A. Costa Souza1; J. Cassoli2; V. Lima1; I.
Gendriz1; F. Cini1; D. Martins-de-Souza2; S. Ribeiro1
1
Brain Institute, Federal University of Rio Grande do Norte (UFRN),
Natal; 2Laboratory of Neuroproteomics, Department of Biochemistry
and Tissue Biology, Institute of Biology, University of Campinas
(UNICAMP), Campinas, Brazil

O139 | Brain state-­dependent cortical

plasticity: the synaptic tagging and consolidation
theory of sleep
J. Seibt1; M.G. Frank 2
1
Surrey Sleep Research Centre, University of Surrey, Guildford, United
Kingdom; 2Department of Biomedical Sciences, Washington State
University, Spokane, WA, United States
Behavioural studies show that sleep is important for the consolida-
tion of experience-­dependent brain plasticity across the lifespan,
but how sleep achieves this function remains poorly understood.
Leading theories (i.e. active consolidation and synaptic homeosta-
sis hypotheses) propose that sleep either strengthens or weakens
synapses to promote efficient integration of waking information.
Caveats are: (1) available data suggest that sleep promotes both
strengthening and weakening of synapses, (2) the role of REM sleep
is vague, and (3) the concept of ‘consolidation’ is not clearly defined.
The latter issue is at the centre of the new theory I will present in this
talk which is based on the long-­standing knowledge that memory
and most forms of synaptic plasticity require de novo protein synthe-
sis to be consolidated over time.
This theory merges data from the sleep, memory and plasticity
fields and proposed that wakefulness, NREM and REM sleep work in
concert to create long-­lasting changes in brain circuitry each using
different, but complementary, types of plasticity mechanisms. More
specifically, waking experience triggers short-­lived synaptic events
that are necessary for transient plastic changes and mark (i.e., ‘tag’)
Slow-­wave sleep (SWS) and rapid-­eye-­movement sleep (REM) im-
pact on memory consolidation through sleep-­dependent changes
in neuronal activity and molecular cascades. To further investigate
their roles, we used electrophysiological recordings and phospho-
proteomic analysis to assess experience-­dependent changes in the
hippocampus (HP) and primary somatosensory cortex (S1) dur-
ing SWS and REM. Proteomic analysis was performed in a two-­
dimensional liquid chromatography-­
t andem mass spectrometry
setup using ion mobility (HDMSE mode) and label-­free quantifica-
tion. The brains were collected from rats exposed to novel objects
for 10 min (+ groups), or from control rats not exposed to novel ob-
jects (-­groups). The animals were kept awake for 3 hours and were
killed after a period rich in SWS or REM (n = 3 per group). The analy-
sis indicates that the brain proteomes exhibit differences in num-
bers of proteins and phosphoproteins identified by phosphoryl (STY)
tags, where a total of 468 validated proteins were identified in S1
and 240 in the HP. The initial approach has been conducted com-
paring the proteomic profile of the treatments and regions (SWS+ x
SWS-­, REM+ x REM-­, REM+ x SWS+ and REM-­x SWS-­). By submit-
ting the identified phosphoproteins to clustering analysis, we found
that 51 proteins from S1 were sufficient to separate the four ex-
perimental conditions, while 37 from HP partially separated groups.
A comparison of the treatments by fold change analysis identified
90 phosphoproteins significantly modulated. They were related to
synaptic function, actin-­microtubule regulation, DNA-­RNA bind-
ing, proteases-­
phosphatases-­
kinases, and other regulatory func-
tions. Interestingly, in the HP of rats exposed to novelty (comparison
REM+ versus SWS+), there was a specific down-­regulation of the
ABSTRACTS
phosphorylation level of a voltage-­gated calcium channel subunit
(CACNA2). This could potentially lead to a hippocampus-­specific,
REM-­dependent downregulation of synaptic plasticity of rats ex-
posed to novel objects. We also found that the phosphorylated level
of Reelin is upregulated in S1 during REM sleep compared to SWS,
in proportion to the number of cortical spindles during the SWS to
REM transition. Altogether, these REM-­
dependent phosphoprot-
eomic differences between HP and S1 may have important implica-
tions for memory corticalization during sleep.
Disclosure: Nothing to disclose.
O141 | An increase in cortical plasticity
facilitates episodic memory and leads semantic
interference effect possible due to REM sleep
I. Navarro-Lobato; A. Aleman; M. Borges; A. Samanta; A.
Alonso; L. Genzel
Neuroinformatics, Donders Institute for Brain, Cognition and
Behaviour/Radboud University, Nijmegen, The Netherlands
Memory formation involves complex processes and different brain
areas, with a key role of the hippocampus and the neocortex. The
most accepted theoretical view seems to postulate that the expo-
sition to a new information induces early and rapid enhancements
in plasticity processes within the hippocampal circuits; whereas re-
peated hippocampal-­neocortical interactions are required to slowly
reorganize neocortical circuits. The difference in learning rate be-
tween hippocampus and neocortex has been supposed to facilitate
the progressive integration of new knowledge avoiding interference
and it is a key point in the theory of memory system consolidation,
which still requires experimental verification. In the present study,
the isoform of 414 amino acids of the regulator of heterotrimeric G
protein signalling 14 (rgs14 414) is overexpressed in the medial pre-
frontal cortex (mPFC) to increase plasticity in adult rats and its ef-
fect on explicit memory consolidation is addressed. Using the Object
Space Task, a newly developed multi-­trial object-­location task, rats
are tested for semantic-­like and episodic-­like memories 24 h and
72 h after training. Interestingly, by rendering the prefrontal cortex
more plastic via the overexpression of rgs14 414 made the usually ro-
bust abstracted memory become vulnerable to an interference trial
at 24 h. In contrast, simple episodic memory was strengthened by
RGS14 414 (RGS14 414 n = 20 vs control, n = 17; p < 0.05) Interestingly,
in control animals the interference event led the original abstracted
memory to be more long lasting (72 h instead of only 24 h).
Sleep has been widely involved in memory system consolidation.
Spontaneous ‘replay’ of memory information mainly during Non-­
Rapid Eye Movement sleep (NREM) initiated in the hippocampal
activity may act as a training signal for the neocortex itself. Rapid
eye movement sleep (REM) promotes cortical plasticity that consoli-
date waking experience in the developing brain. Therefore, we study
the possible implications of RGS14 414-­mediated cortical plasticity in
|
      69 of 356
sleep architecture and the cortical-­hippocampal interaction during
sleep. Thus, 8 animals (4 per group) are implanted with a light micro-
drive containing 16 movable tetrodes (6 in the hippocampus and 10
in the prefrontal cortex). Extracellular electrophysiological record-
ings in freely moving animals are performed during the task perfor-
mance and in the resting periods between trials.
Disclosure: Nothing to disclose.
Pos ter s
P OS TE R N E T WO R K I N G LO U N G E
P01 | Key components of the pulse wave
amplitude signal during sleep are associated with
prevalent hypertension in two large community
samples
F. Decup1; B. Lechat1; S. Appleton1; K. Hansen1; B.
Zajamsek1; A. Vakulin1; R. Adams1; D. Eckert1; C. Hirotsu2; R.
Heinzer2; P. Catcheside1
1
Flinders University, Adelaide, SA, Australia; 2CHUV-­EPFL, Lausanne,
Switzerland
Objectives/Introduction: The HypnoLaus study is one of the larg-
est studies to have examined relationships between sleep and car-
diovascular problems in the community. A HypnoLaus sub-­study
found non-­invasive finger photoplethysmography (PPG) signals to
be predictive of prevalent hypertension suggesting significant po-
tential value of PPG disturbances for assessing future cardiovascular
risks. Accordingly, this study sought to confirm and cross-­validate
associations between PWA-­drop features and prevalent hyperten-
sion using a different automatic detection algorithm applied to an in-
dependent large population-­based sample from the Men Androgen
Inflammation Lifestyle Environment and Stress (MAILES) study and
when combined with both the HypnoLaus study sample.
Methods: All-­night recordings from full in-­home polysomnography
in 2162 individuals (HypnoLaus) and 752 men (MAILES) with finger
PPG recordings were processed following exclusion of artefacts (e.g.
ectopic beats, probe off, movement artefacts). Pulse wave amplitude
(PWA)-­drops were derived from the PPG signal and processed using
an independently developed algorithm that searches for transient
vasoconstriction responses in the PPG signal. Associations between
key PWA-­drop features (mean duration and mean area under the
curve (AUC)) with prevalent hypertension were analysed using
multivariable-­
adjusted logistic regression for the MAILES cohort
and for both cohorts pooled together. Results are reported as odds
ratio (OR) with 95% confidence intervals comparing the lowest to
the highest quartile of each PWA metric.
 |
70 of 356       ABSTRACTS
Results: The analysis included 2125 individuals (59 ± 11 years,
51% women, 41% hypertension) from the HypnoLaus cohort, and
738 men (61 ± 11 years, 53% hypertension) from the MAILES co-
hort. Similar to recently reported data from the HypnoLaus cohort,
a greater AUC was associated with prevalent hypertension in the
MAILES cohort (OR  =  1.84 [1.10–3.08]) and in the pooled dataset
(OR  =  1.34 [1.02–1.75]). A longer PWA-­drop duration was associ-
ated with prevalent hypertension in the pooled dataset (OR = 1.31
[1.01–1.70]). However, while the point estimates were in the same
direction, there were no significant associations for PWA-­drop mean
duration when either cohort was assessed independently.
Conclusions: These findings using a new algorithm provide further
support that key components of the PWA signal during sleep are
associated with prevalent hypertension. Further work to investigate
potential gender differences is warranted.
Disclosure: Nothing to disclose.
P02 | Development of predictive model for
obstructive sleep apnea using machine learning
H.W. Kim; J.W. Cho; D.J. Kim
Neurology, Pusan National University Yangsan Hospital, Yangsan,
Republic of Korea
Objectives/Introduction: The aim of this study was to develop a pre-
dictive model for obstructive sleep apnea (OSA) with minimal clinical
information of patients using machine learning.
Methods: We collected 1378 data and defined OSA following the
AH (apnea-­hypopnea) index, and set the explanatory variables that
are known as related to snoring including the age, height, weight,
body mass index, neck circumference, waist circumference, hip cir-
cumference, head circumference, Epworth sleepiness scale, Beck
depression inventory and past medical history of hypertension or
diabetes mellitus or heart disease. These variables have characteris-
tics that patients can measure themselves without going to the hos-
pital or undergoing an examination. We use 1000 data out of 1378
collected data to develop diagnosis models and test each models’
performance by using rest 378 data. We consider 5 machine learn-
ing methods including LASSO Logit (or Probit) model, Support vec-
tor machine (SVM) model, K-­Nearest Neighbor (KNN) model, Baive
Bayes (NB) and discriminant analysis (DA) for OSA diagnosis model.
Results: Five machine learning methods for diagnosing OSA showed
relatively high level of accuracy (68.8% ~ 86.8%) and precision (74.3%
~ 87.7%). The model from the KNN (K-­Nearest Neighbors) method
shows 86.77% accuracy and 87.72% precision when patients with
AHI are over 5, that is, those who can be diagnosed with OSA. When
patients with AHI over 30 can be diagnosed as severe OSA, accuracy
and precision are 84.92% and 80.15% respectively. The results indi-
cate that the model used by the KNN method is better at least about
10% that other model in terms of accuracy and precision.
Conclusions: The model derived from the KNN method represents
the best performance. We confirmed that OSA can be reliably diag-
nosed with minimal clinical information using machine learning.
Disclosure: Nothing to disclose.
P03 | Associations between NREM and REM
sleep EEG spectral power, amyloid burden, grey
matter volume and perfusion in ageing
C. André1,2; S. Réhel1,2; E. Kuhn1; E. Touron1; F. Mézenge1;
S. Segobin2; F. Bertran2,3; V. de La Sayette2,4; D. Vivien1,5; G.
Chételat1; G. Rauchs2; the Medit-Ageing Research Group
1
Normandie Univ, UNICAEN, INSERM, U 1237, PhIND ‘Physiopathology
and Imaging of Neurological Disorders’, Institut Blood and Brain
@ Caen-­Normandie, Cyceron; 2Normandie Univ, UNICAEN, PSL
Université, EPHE, INSERM, U 1077, CHU de Caen, GIP Cyceron, NIMH;
3
Unité d'Exploration et de Traitement des Troubles du Sommeil, CHU
de Caen; 4Service de Neurologie, CHU de Caen; 5Département de
Recherche Clinique, CHU Caen-­Normandie, Caen, France
Objectives/Introduction: Sleep changes are increasingly acknowl-
edged as a risk factor for Alzheimer's disease (AD). However, how
they may relate to AD pathophysiology is still unclear, as we lack
studies combining objective sleep measures and in vivo neuroimag-
ing. Our objective was to assess the relationships between both non-­
rapid eye movement (NREM) and rapid eye movement (REM) sleep
EEG spectral power and amyloid burden, grey matter (GM) volume
and perfusion in cognitively normal older adults (CN).
Methods: 125 CN older participants from the Age-­Well randomized
controlled trial underwent a neuropsychological assessment, a
structural MRI measuring GM volume, and a Florbetapir-­PET scan,
with early and late acquisitions to measure brain perfusion and amy-
loid burden respectively. An ambulatory polysomnography was per-
formed, and normalized EEG spectral power values were obtained
using the ASEEGA® algorithm for delta (0.1–4 Hz), theta (4–8 Hz),
alpha (8–12 Hz) and beta (16–50 Hz) frequency bands, separately for
NREM and REM sleep, over the Cz-­Pz derivation. Voxel-­wise mul-
tiple regressions were conducted between spectral power values
and neuroimaging data, controlling for age, gender, education, the
apnea-­hypopnea index, sleep medication use, and the ApoE4 sta-
tus. Results were considered significant at a p < 0.005 (uncorrected)
threshold combined with a cluster-­level FWE correction.
Results: GM volume in fronto-­cingulate areas positively correlated
to NREM sleep delta power (p < 0.001), and negatively correlated
to NREM sleep alpha (p = 0.006) and beta (p = 0.001) powers. In
addition, perfusion in the same areas was positively associated with
NREM sleep (p < 0.001) and REM sleep (p < 0.001) delta power,
and negatively associated with REM sleep beta power (p = 0.035).
Besides, REM sleep theta power was positively associated GM vol-
ume in frontal, temporal, insular and occipital cortices (p < 0.001),
and negatively associated with perfusion in fronto-­parietal areas
(p = 0.005). Importantly, REM sleep theta power negatively correlated
ABSTRACTS
to amyloid burden mainly in fronto-­cingulate and temporo-­parietal
regions (p < 0.001).
Conclusions: Both NREM and REM sleep alterations were associ-
ated with structural and functional changes in regions vulnerable to
neurodegeneration in ageing and AD. Only REM sleep theta power
changes were associated with greater amyloid deposition, sugges-
tive of an increased risk of developing Alzheimer's disease.
Disclosure: Nothing to disclose.
P04 | Tissue inhibitor of matrix
metalloproteinase-­1 and hypoxia-­inducible
factor-­1 alpha levels in atrial fibrillation patients
with obstructive sleep apnea/hypopnea
syndrome
T. Balabanovich1; V. Shyshko2
1
Department of Internal Medicine I; 2Department of Internal Medicine
II, Grodno State Medical University, Grodno, Belarus
Objectives/Introduction: Obstructive sleep apnea-­
hypopnea
syndrome (OSAHS) is associated with atrial fibrillation (AF) but
its pathophysiology in AF remains largely unknown. Both appear
to lead to hypoxia which has been implicated in the activation of
hypoxia-­inducible factor (HIF) pathway that may induce systemic
inflammation and changes in the extracellular matrix of the heart.
Our aim was to evaluate serum levels of tissue inhibitor of matrix
metalloproteinase-­1 (TIMP-­1) and HIF-­1α in AF patients and com-
pared them with AF patients with co-­existing OSAHS, and evaluated
the relationship between these biomarkers and risk of AF recurrence
in study sample.
Methods: We enrolled into the study 140 patients with AF (mean age
55.72 ± 7.97 years; 70.71% males). In addition to standard examina-
tion, a cardiorespiratory monitoring was conducted in the study sub-
jects and they were divided into 2 age-­and gender-­matched groups
according to the presence of OSAHS. Serum levels of HIF-­1α and
TIMP-­1 were assayed using commercially available Human HIF-­1α
ELISA kit (№EH0551) and Human TIMP-­1 ELISA kit (№EH0294)
(Wuhan Fine Biotech Corporation, China). All statistical analyses
were performed using STATISTICA 10.0 (Start Soft Inc., USA).
Results: There were 100 (71.4%) confirmed OSAHS patients among
the study sample. The serum TIMP-­1 level and HIF-­1α level in group
2 was higher than in the group 1 (p < 0.05). In the study sample there
was positive statistical correlation between TIMP-­1 level and oxygen
desaturation index (ODI), and apnea-­hypopnea index (AHI) (r = 0.424
and r = 0.425 respectively; p < 0.05) and significant correlation
between HIF-­1α and ODI, and AHI (r = 0.713 and r = 0.64 respec-
tively; p < 0.05). 116 patients in the sample underwent successful
cardioversion. The recurrence rate of AF at 12 months was 61.2%.
Multivariate analysis for predictors of recurrence of AF revealed that
AHI, duration of AF, TIMP-­1 level, LA size and LV ejection fraction
|
      71 of 356
were associated with AF recurrence: the prediction model for AF re-
currence was developed (sensitivity = 80.28%, specificity = 77.78%).
Conclusions: Serum levels of TIMP-­1 and HIF-­1α are elevated in AF
patients with OSAHS. A predictive model, which will help to iden-
tify high-­risk patients with AF recurrence during the first year after
electrical cardioversion in patients with AF, suffering from OSAHS,
was elaborated.
Disclosure: Nothing to disclose.
P05 | The role of hyaluronic acid and
hyaluronidase-­1 in obstructive sleep apnoea
M. Meszaros1; A. Kis1; L. Kunos1; A.D. Tarnoki2; D.L.
Tarnoki2; Z. Lazar1; A. Bikov3
1
Department of Pulmonology; 2Medical Imaging Centre, Semmelweis
University, Budapest, Hungary; 3Manchester University NHS
Foundation Trust, Manchester, United Kingdom
Objectives/Introduction: Biological functions of hyaluronic acid
(HA) depend on its molecular size. Under inflammation or hypoxia
high-­molecular weight HA (HMW-­HA) is degraded by hyaluroni-
dases (mainly by HYAL-­1) and low-­molecular weight HA (LMW-­HA)
induces production of pro-­
inflammatory cytokines. Obstructive
sleep apnoea (OSA) is characterised by chronic intermittent hypoxia
with consequential systemic inflammation and increased levels of
pro-­inflammatory biomarkers. The aim of this study to evaluate cir-
culating HMW-­HA and HYAL-­1 in OSA.
Methods: Sixty-­eight patients with OSA (median 53 years /47–64/,
72% men) and forty control volunteers (51 /39–60/ years, 28%
men) were recruited. After full-­night cardiorespiratory polygraphy
or polysomnography blood pressure was measured and blood sam-
ples were taken for glucose, lipid profile, CRP, HMW-­HA and HYAL-­1
measurements.
Results: HYAL-­1 levels were significantly higher in patients with OSA
patients compared to the control subjects (0.59 /0.31–0.88/ ng/mL
vs. 0.31 /0.31–0.58/ ng/mL; p = 0.005) after adjustment for gen-
der, age and BMI. There was a trend for lower HMW-­HA concen-
trations in OSA compared to controls (31.63 /18.11–59.25/ ng/mL
vs. 46.83 /25.41–89.95/ ng/mL; p = 0.068). Significant correlation
was detected between circulating HMW-­HA and AHI (r  =  −0.195,
p = 0.043), HYAL-­1 and AHI (r = 0.30, p < 0.01) and ODI (r = 0.26,
p < 0.01).
Conclusions: Our results suggest that chronic hypoxia is associ-
ated with increased plasma HYAL-­1 concentration and accelerated
HMW-­HA degradation. Altered hyaluronan metabolism may be in-
volved in the systemic inflammatory cascade in OSA.
Disclosure: Nothing to disclose.
 |
72 of 356       ABSTRACTS
P06 | Selective orexin 2 receptor agonist TAK-­
925 to treat narcolepsy: results of a randomized,
double-­blind, placebo-­controlled, multiple-­
ascending-­dose, phase 1 study in patients with
narcolepsy type 1
S.-I. Tanaka1; R. Evans2; R. Alexander2; M. Imazaki1; S.
Touno1; K. Shimizu1; J. Wu2; H. Faessel2; E. Ratti2; D.
Hartman2
1
Takeda Development Center Japan, Takeda Pharmaceutical Company
Limited, Osaka, Japan; 2Neuroscience Therapeutic Area Unit, Takeda
Pharmaceuticals International Co., Cambridge, MA, United States
Objectives/Introduction: To evaluate safety, tolerability, pharma-
cokinetics, and pharmacodynamics of multiple doses of TAK-­925 in
patients with narcolepsy type 1 (NT1). NT1 is a rare neurological dis-
order characterized by excessive daytime sleepiness (EDS) and cata-
plexy. TAK-­925, a selective orexin 2 receptor agonist, was previously
evaluated in a first-­in-­human study showing wake-­promoting effects
in an NT1 population administered a single IV infusion. We report
results from a Phase 1 multiple-­ascending-­dose study of TAK-­925 in
NT1 patients (ClinicalTrials.gov identifier: NCT03748979).
Methods: Eligible NT1 subjects (18–80 years, International
Classification of Sleep Disorders, third edition criteria) were rand-
omized (4:2) to TAK-­925 or placebo in each of two dose cohorts in
which multiple ascending dose levels of TAK-­925 were administered
daily by 9-­hour IV infusion for 7 days. Subjects were required to wash
out all therapies used for treatment of NT1 prior to randomization.
Results: Of the 18 NT1 subjects screened, 13 (median age, 32 years
[range: 18–43]; male, 61.5%) were randomized. Overall baseline
disease profile showed existence of EDS symptoms in both objec-
tive and subjective measurements (Maintenance of Wakefulness
Test (MWT) baseline mean sleep latency, 3.24 minutes; Epworth
Sleepiness Scale median total score, 18), which were consistent
with baseline characteristics in other NT1 trials. Daily IV infusions
of TAK-­925 were generally safe and well tolerated at both doses
evaluated (11 mg and 44 mg). Multiple-­dose pharmacokinetics were
consistent with single-­dose data reported previously. Results of both
MWT and ESS in NT1 subjects suggested dose-­dependent increases
in wakefulness on Day 1; the effect was maintained after repeated
administration of TAK-­925 until Day 7. Given the data, the posterior
probabilities of increased wakefulness over placebo at both doses
are above 70%. In patients with NT1, the mean number of cataplexy
episodes during infusion in the 7-­day treatment period reduced from
5.8 to 0 in the TAK-­925 11 mg group and from 3.2 to 0 in the TAK-­
925 44 mg group, compared with a change of 2.3 to 1.8 in the pla-
cebo group.
Conclusions: The current results extend previous findings and sup-
port further development of an orexin 2 receptor agonist as a prom-
ising approach for the treatment of EDS and cataplexy in NT1.
Disclosure: Study supported by: Takeda Pharmaceutical Company.
Shin-­Ichiro Tanaka is a full-­time employee of Takeda Pharmaceutical
Company. Rebecca Evans is a full-­
time employee of Takeda
Pharmaceutical Company. Robert Alexander is a full-­time employee
of Takeda Pharmaceutical Company. Manami Imazaki is a full-­time
employee of Takeda Pharmaceutical Company. Shunsuke Touno is
a full-­
time employee of Takeda Pharmaceutical Company. Kohei
Shimizu is a full-­time employee of Takeda Pharmaceutical Company.
Jingtao Wu is a full-­
time employee of Takeda Pharmaceutical
Company. Helene Faessel is a full-­
time employee of Takeda
Pharmaceutical Company. Emiliangelo Ratti is a former employee
of Takeda Pharmaceutical Company. Deborah Hartman is a full-­time
employee of Takeda Pharmaceutical Company.
P07 | Infant sleep during COVID-­19 in the USA:
longitudinal analysis of auto-­videosomnography
data
M. Kahn1; N. Barnett2; A. Glazer2; M. Gradisar1
1
Flinders University, Adelaide, SA, Australia; 2Research Department,
Nanit, New York, NY, United States
Objectives/Introduction: The recent outbreak of COVID-­19 has had
a massive effect on human lives. By March 21st 2020, most people
in the USA were asked to ‘shelter in place’, with exceptions limited
mostly to essential workers continuing their work outside of the
house. These dramatic restrictions have had a widespread impact
on daily routines, health and well-­being. The present study aimed
to compare the sleep of infants in the USA whose mothers were
‘sheltering in place’ to those whose mothers were working as usual
throughout the COVID-­19 pandemic.
Methods: Mothers of 602 infants aged 1–30 months (47% girls,
Mage = 6.8, SD = 5.6) participated in this longitudinal study.
Assessments were conducted on 4 occasions, once every 2 weeks
from mid-­
March to mid-­
May 2020. On each assessment, infant
sleep was measured objectively using auto-­videosomnography for
10 consecutive days in the naturalistic home-­setting using a Nanit
camera. Infant sleep was additionally reported via 4 online surveys,
in which mothers also reported whether they were working outside
the house or solely ‘sheltering in place’.
Results: Generalized estimating equations revealed that over time,
infants of mothers ‘sheltering in place’ had later objective sleep offset
times (Mdifference = 11.7 mins, Wald = 6.78, p = 0.009), more parental
nighttime crib visits (Mdifference = 0.36 visits, Wald = 4.53, p = 0.03)
and longer reported daytime sleep durations (Mdifference = 12.4 mins,
Wald = 5.26, p = 0.02), compared with infants of mothers who worked
outside the house. Furthermore, significant time-­by-­'sheltering sta-
tus’ interaction effects emerged for the number of objectively meas-
ured parental nighttime visits (Wald = 18.44, p < 0.001) and sleep
onset time (Wald = 11.55, p = 0.009). These indicated that infants
of mothers ‘sheltering in place’ had earlier bedtimes and more night-
time crib visits at the end of March, whereas differences were not
apparent in April and May.
ABSTRACTS
Conclusions: Infants of mothers who ‘sheltered in place’ were visited
more frequently during the night, woke later in the morning and took
longer naps, when compared to infants of mothers who were work-
ing as usual during COVID-­19. Differences were mostly apparent at
the end of March, suggesting that living restrictions issued around
mid-­March in the USA may have led to temporary delays in sleep
consolidation, which subsided as time progressed.
Disclosure: Funding: This study was supported by Nanit. Conflict
of interest statement (a) Financial Disclosure: MG has served a Pro-­
Bono consultant for Nanit. NB and MK have served as consultants
for Nanit. AG was an employee of Nanit at the time of study imple-
mentation. (b) Non-­financial Disclosure: none.
P08 | Association between insomnia and
subjective cognitive functioning: a population-­
based study
I. Hwang1,2; D. Oh2; J.-E. Yoon2; D. Kim3; K.I. Yang4; M.K.
Chu5; S.-H. Park 2; C.-H. Yun2
1
Neurology, Veterans Health Service Medical Center, Seoul;
2
Neurology, Seoul National University College of Medicine, Seoul
National University Bundang Hospital, Seongnam; 3Neurology,
Chungnam National University College of Medicine, Chungnam
National University Hospital, Daejeon; 4Neurology, Soonchunhyang
University College of Medicine, Soonchunhyang University Cheonan
Hospital, Cheonan; 5Neurology, Yonsei University College of Medicine,
Severance Hospital, Seoul, Republic of Korea
Objectives/Introduction: Insomnia has been linked to impairments
in cognitive function across a range of domains. However, increas-
ing research suggests that subjective cognitive decline (SCD) in the
absence of objective cognitive dysfunction may be a forerunner of
non-­normative cognitive decline and eventual progression to de-
mentia. Emerging data suggest that subjective report of cognitive
change is a sensitive marker of cognitive decline at the preclinical
stage of Alzheimer's disease. In the representative sample of the
adult population, we demonstrated an association between insom-
nia disorder and subjective cognitive functioning in everyday life.
Methods: A stratified random sample (2466 subjects; age
19–92 years old, mean 47.9 ± 16.4, 1217 male) from the general
population was evaluated, in 2018, using face-­to-­face interviews. To
evaluate insomnia and its severity, the Insomnia Severity Index (ISI)
was applied. To assess subjective cognitive functioning, we adopted
the Mail-­In Cognitive Function Screening Instrument (MCFSI). The
MCFSI is a brief, self-­administered potential outcome measure de-
veloped by the Alzheimer's Disease Cooperative Study (ADCS) to
detect early changes in cognitive and functional abilities in individu-
als without clinical impairment. MCFSI scores ≥5 were considered
abnormal for this study. Education years, sleep duration, excessive
daytime sleepiness, alcohol, smoking, regular exercise, anxiety, de-
pression, habitual snoring, BMI, HTN and DM status were included
|
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as covariates in the analysis to control for potential confounding. The
associations between insomnia and subjective cognitive functioning
were examined with logistic regression models adjusted for lifestyle
and clinical factors.
Results: Subjective cognitive functioning was abnormal in 526 sub-
jects (21.3%). Severe, moderate and subthreshold insomnia were
associated with significantly worse subjective cognitive functioning
compared with no insomnia (OR 3.59, 95% CI 1.20–10.75, p = 0.022
in severe insomnia; OR 2.79, CI 1.641–4.753, p  ≤  0.001 in moder-
ate insomnia; OR 2.10, 95% CI 1.62–2.73, p ≤ 0.001 in subthreshold
insomnia). Subjective cognitive functioning was significantly associ-
ated with older age, anxiety, depression, habitual snoring, excessive
daytime sleepiness and higher education.
Conclusions: The results from this survey cohort provide evidence
at the population level that insomnia is associated with worse sub-
jective cognitive functioning.
Disclosure: Nothing to disclose.
P09 | The impact of home confinement due
to COVID-­19 pandemic on sleep quality and
insomnia symptoms among the Italian population
F. Salfi; G. Amicucci; J. Cascioli; D. Corigliano; L. Viselli; D.
Tempesta; M. Ferrara
Department of Biotechnological and Applied Clinical Sciences,
University of L'Aquila, L'Aquila, Italy
Objectives/Introduction: Italy has been the first European hotspot
of COVID-­19 pandemic, and the first state applying total lockdown
measures implying home confinement of the general population. In
this study, we investigated the consequences of this unprecedented
confinement on the Italian population's sleep.
Methods: 13989 Italian citizens (aged 34.8 ± 12.2, 18–86, 3223
males) completed a web-­based survey during the entire home con-
finement period (25th March–3rd May). The survey comprised:
Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI),
reduced Morningness-­Eveningness Questionnaire, Beck Depression
Inventory, Perceived Stress Scale, State-­Trait Anxiety Inventory, and
a demographic questionnaire. Furthermore, 2123 participants of the
first 4 days of data collection (before summertime implementation)
were retested 4 weeks later, to evaluate the changes in the above
variables during the protracted home confinement period.
Results: Participants declared going to bed and waking up later
(58.8% and 63.3%, respectively), and 60.5% reported a sleep qual-
ity worsening. 58.0% were poor sleepers according to PSQI cut-­off
(overall mean 7.05 ± 3.69), and 15.1% reported moderate/severe
insomnia symptoms (overall ISI mean 8.43 ± 5.59). Multiple regres-
sion models with PSQI and ISI scores as dependent variables, using
the other questionnaires scores and demographic information (age,
gender, occupation, education) as predictors, resulted significant
(R2 = 0.30; R2 = 0.35, respectively; both p ≤ 0.001), as well as all the
 |
74 of 356       ABSTRACTS
predictors (all p  ≤ 0.01). In particular, females, older, low education,
and evening-­type people showed the highest PSQI and ISI scores.
Health workers were the poorest sleepers, while smart workers
showed the best sleep quality. ANOVA assessing the time-­course
of PSQI and ISI scores across the confinement period revealed a
significant worsening of sleep quality and insomnia symptoms over
time (both p ≤ 0.001). Consistently, mixed model analysis comparing
test-­retest scores confirmed the sleep quality deterioration control-
ling for the covariance of depression, stress, and anxiety (p = 0.002).
Males, younger and older people, and individuals reporting an in-
creased exposition to backlit screens before bedtime showed the
largest sleep impairment.
Conclusions: Our investigation depicts a population of poor sleep-
ers during COVID-­19 outbreak. The prolonged home confinement
had a direct and cumulative negative impact on sleep quality, inde-
pendently of other psychological variables. Our results highlight the
urgency to predispose sleep-­focused interventions, in particular for
the most vulnerable categories.
Disclosure: Nothing to disclose.
P10 | A 3.5-­year follow-­up of combined CBT-­I
and chronotherapy shows stronger long-­term
effects on mood than on insomnia severity
O. Lakbila-Kamal1,2; J.E. Reesen1; J. Leerssen1,2; J.C. Foster-
Dingley1; S.L.C. Ikelaar1; L. Vergeer1; A.C.W. Albers1; Y.J.
De Graaf1; T.F. Blanken1; K. Dekker1; T. Maksimovic1; W.F.
Hofman3,4; A. vanStraten5; E.J.W. Van Someren1,2,6
1
Department of Sleep and Cognition, Netherlands Institute for
Neuroscience, an Institute of the Royal Netherlands Society for Arts
and Sciences; 2Department of Integrative Neurophysiology, Center
for Neurogenomics and Cognitive Research (CNCR), Amsterdam
Neuroscience, VU University Amsterdam; 3Department of Psychology,
Brain and Cognition group, University of Amsterdam; 4Personal
Health Institute International; 5Department of Clinical Psychology,
VU University Amsterdam & EMGO Institute for Health Care and
Research; 6Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam
Neuroscience, Amsterdam, The Netherlands
Objectives/Introduction: Insomnia is probably the strongest risk fac-
tor for the development of depression (Blanken, Lancet Psychiatry
2019;6:285; Blanken, Sleep 2019;43:zsz288). Cognitive Behavioral
Therapy for Insomnia (CBT-­I) is the treatment of choice to ameliorate
insomnia. When applied to people with both insomnia and depres-
sion, CBT-­I moreover ameliorates depression.
Few studies however investigated whether CBT-­I effects on insom-
nia persist over years, and virtually no study investigated whether
CBT-­I can mitigate the risk of depression over time.
Methods: We therefore here followed-­up 134 people suffering from
insomnia disorder across a period of 3.5 years. Of them, n = 107
were randomized to receive CBT-­I either as stand-­alone treatment
(n = 26) or in combination with scheduled chronotherapy, being ei-
ther bright light (n = 26), physical activity (n = 27) or warm baths
(n = 28) (Dekker, Psychother Psychosom 2019;89:117). A fifth group
was followed-­up across the same 3.5 years (n = 27), without being
aware of the parallel intervention study.
At onset, after intervention and after 3.5 years, insomnia severity
was quantified using the Insomnia Severity Index (ISI). The devel-
opment of depression and/or dysthymia was assessed at 3.5 years
by blinded trained interviewers using the Composite International
Diagnostic Interview (CIDI).
Results: During the 3.5 years follow-­up, 48% of the people that had
not received any intervention had experienced clinical depression
and/or dysthymia, versus 21% of all participants that had received
CBT-­I (Chi-­Square 8.5, p = 0.004). Disordered mood was least likely
to have occurred in people that combined CBT-­I with chronotherapy
(Chi-­Square 4.2, p = 0.04): 15% with added light or physical activity,
18% with added baths. Disordered mood was twice as likely (35%)
to have occurred among people that received CBT-­I only, without
chronotherapeutic intervention. Insomnia severity improvements
induced by the interventions were largely maintained after 3.5 years
although many still experienced clinically significant insomnia: the
decrease after 3.5 year was not significantly different than the spon-
taneous decrease in people that had not received treatment.
Conclusions: In conclusion, the findings indicate that future disor-
dered mood in people with insomnia can be prevented by means of
CBT-­I, and even better if a chronotherapeutic intervention is added.
The findings moreover indicate that for many, clinically significant
insomnia complaints remain even after CBT-­I and chronotherapy.
Disclosure: Nothing to disclose.
P11 | Behavioural and physiological
investigations into sleep in sharks
M. Kelly1,2; S. Spreitzenbarth3; E. Murray3; C. Kerr1; P.-A.
Libourel4; C. Radford3; J. Hemmi2; S. Collin1; J. Lesku1
1
School of Life Sciences, La Trobe University, Melbourne, VIC; 2School
of Biological Sciences, The University of Western Australia, Perth, WA,
Australia; 3Institute of Marine Science, The University of Auckland,
Auckland, New Zealand; 4Centre de Recherche en Neurosciences de
Lyon, Centre National de La Recherche Scientifique, Lyon, France
Objectives/Introduction: All vertebrates studied thus far engage in
some form of sleep behaviour (restfulness, increased arousal thresh-
old, homeostatic regulation) and changes in physiology (respiratory
and heart rates, brain activity), but there is currently no data on the
presence or form of sleep in cartilaginous fishes. As sharks represent
the earliest stage in the evolution of jawed vertebrates, they may
hold important clues to the evolution of sleep in more derived ani-
mals. This study examines the behavioural and physiological indica-
tors of sleep in two benthic species of shark, Australia's Port Jackson
ABSTRACTS
shark (Heterodontus portusjacksoni) and New Zealand's draughts-
board shark (Cephaloscyllium isabellum).
Methods: We investigated the presence of endogenous circadian
rhythms of restfulness in both species by manipulating ambient light
levels under laboratory conditions. We then tested for increased
arousal thresholds during prolonged periods of inactivity using an
electrical pulse stimulus. Finally, sharks were deprived of rest to test
for a compensatory increase in restfulness during their normal active
period following enforced swimming.
Results: Both species show a nocturnal activity pattern which is tem-
porarily retained in the absence of photoperiodic cues (Port Jackson
sharks: n = 8; draughtsboard sharks: n = 8), and an increased arousal
threshold during prolonged periods of inactivity (Port Jackson
sharks: n = 7, p < 0.01; draughtsboard sharks: n = 10, p < 0.01). We
found no evidence, however, that sleep is homeostatically regulated
in either species, as sharks did not recover lost sleep by sleeping
more when allowed to behave freely (Port Jackson sharks: n = 5;
draughtsboard sharks: n = 8).
Conclusions: Our findings of circadian organisation of activity pat-
terns, and spontaneous and reversible periods of quiescence, which
coincide with reduced responsiveness to electrical stimulation, are
the first direct evidence for the presence of sleep in any cartilagi-
nous fish. Further investigation is needed to fully understand how
such sleep is regulated in these animals. Ongoing research is focusing
on the metabolic and neurophysiological indicators of sleep in these
species, in addition to examining sharks that swim continuously.
Disclosure: Nothing to disclose.
P12 | Sex-­induced, male-­specific sleep loss in
Antechinus
1 1 2 3
E. Zaid ; F. Rainsford ; P. Meerlo ; J. Lesku
1
School of Life Sciences, La Trobe University, Melbourne, VIC, Australia;
2
Groningen Institute for Evolutionary Life Science, University of
Groningen, Groningen, The Netherlands; 3La Trobe University | School
of Life Sciences, La Trobe University, Melbourne, VIC, Australia
Objectives/Introduction: Sleep is a prominent, seemingly universal
behaviour. Although there is broad consensus that sleep maintains
optimal waking performance, the drive to sleep may be incompat-
ible with the life-­history and ecology of some species. For instance,
sleeplessness may be favoured in polygynous males during the
breeding season to maximize fitness. Perhaps the best mammal
candidate for the seasonal suppression of sleep is antechinus, small
dasyurid marsupials with an unusual reproductive strategy charac-
terised by the synchronous death of all males at the end of their
only breeding season. We hypothesised that 1) only male antechinus
would increase activity during the breeding season and 2) the in-
creased activity in breeding males reflects sleep loss.
Methods: Over multiple years, dusky antechinus (A. swainsonii;
n = 15, 10 males) were trapped in the wild and housed individually
|
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in naturalistic outdoor enclosures before the onset of the mating
period. Activity was recorded continuously using small, lightweight
accelerometers, and nestbox video recordings. Furthermore, blood
was sampled every 15 days to determine whether metabolite or en-
docrine changes, such as oxalic acid and testosterone, can be used to
predict individual sleep amount; urine was sampled to determine the
onset of the breeding season. Blood was also incidentally collected
from wild agile antechinus (A. agilis; n = 38, 20 males) to yield oxalic
acid data with a greater sample size and from wild animals.
Results: Preliminary results on a subset of data show that males and
females are active 28% and 33% of the 24-­h day, respectively, be-
fore the breeding season. In males (p = 0.006), but not females, the
amount of activity increases significantly during the breeding sea-
son. Furthermore, the amount of oxalic acid (a possible biomarker
for sleep loss in mammals) in wild agile antechinus decreased sig-
nificantly in males (p = 0.041) across the breeding season, providing
some evidence for its use as a measure of sleep loss in marsupials;
however, no such relationship was found in the captive dusky ante-
chinus, perhaps owing to the ad libitum provisioning of food.
Conclusions: These results build on growing evidence for remark-
able, and apparently adaptive plasticity in the amount and timing of
sleep across a diversity of species.
Disclosure: Nothing to disclose.
P13 | Splitting sleep between the night and a
daytime nap is beneficial for declarative memory,
regardless of total sleep opportunity
J.N. Cousins1,2,3; R.L.F. Leong1; S.A. Jamaluddin1; A.S.C. Ng1;
M.W.L. Chee1,2
1
Centre for Sleep and Cognition, National University of Singapore;
2
Neuroscience and Behavioural Disorders Programme, Duke-­NUS
Medical School, Singapore, Singapore; 3Donders Institute for Brain,
Cognition & Behaviour, Radboud University Medical Center, Nijmegen,
The Netherlands
Objectives/Introduction: Napping has been shown to be effec-
tive at enhancing both the encoding and consolidation of memory.
However, previous studies have mostly examined this effect in the
context of a single nap in a laboratory setting. It remains unclear
whether incorporating daily naps into a typical school week would
yield similar benefits to memory. In the current study, we investi-
gated whether daily napping throughout the week remains ben-
eficial for learning when adolescents are either sleep restricted or
getting the recommended amount of sleep.
Methods: Participants (n = 112) between the ages of 15–19 learned
facts about amphibians across three consecutive days. On each day
they learned about six amphibian species in the morning (11:00), and
six different amphibian species in the afternoon (17:00). Participants
were randomised into groups that varied between the factors of
sleep schedule (continuous or split sleep) and sleep opportunity
 |
76 of 356       ABSTRACTS
duration (6.5 or 8 h). This resulted in four groups: 6.5 h-­continuous
(n = 29), 6.5 h-­split (n = 29), 8 h-­continuous (n = 29) and 8 h-­split
(n = 25). Participants with the split sleep schedule napped between
14:00–15:30. Learning was assessed after a night of recovery sleep
(9 h) via 360 two-­alternative forced choice questions.
Results: A mixed ANOVA with the factors of schedule (split/con-
tinuous), duration (6.5 h/8 h), and learning-­
time (morning/after-
noon), showed a significant main effect of schedule (p = 0.010) and
a schedule*learning-­time interaction (p = 0.002). For both durations,
participants with split sleep remembered significantly more facts
about amphibians learned in the afternoon compared to partici-
pants with continuous sleep (8 h-­continuous vs. 8 h-­split: p = 0.043;
6.5 h-­continuous vs. 6.5 h-­split: p = 0.009). In contrast, there were
no differences in morning learning between the different schedules
(8 h-­continuous vs. 8 h-­split: p = 0.236; 6.5 h-­continuous vs. 6.5 h-­
split: p = 0.239).
Conclusions: Splitting sleep between a nocturnal period and a day-
time nap enhanced declarative memory for materials learned in the
afternoon, regardless of the total sleep opportunity across the day.
Crucially, morning learning was not affected from splitting sleep
despite the shorter nocturnal sleep duration. A split sleep sched-
ule may represent a practical strategy to improve learning in sleep-­
restricted adolescents.
Disclosure: Nothing to disclose.
P14 | Reduced sleep time is associated with
increases in frontal sleep-­like activity and
emotion regulation failures
G. Avvenuti1; D. Bertelloni2; G. Lettieri1; E. Ricciardi1; L.
Cecchetti1; P. Pietrini1; G. Bernardi1
1
Momilab, IMT School for Advanced Studies Lucca, Lucca; 2University
of Pisa, Pisa, Italy
Objectives/Introduction: Emotional self-­
regulation consists in
modulating the subjective experience of a given emotion and/or its
prompted behavioral expression. Sleep restriction or deprivation
is associated with an impairment in the regulation of emotional re-
sponses thought to depend on an altered prefrontal ‘control’.
Interestingly, recent studies demonstrated that extended wakeful-
ness leads to the appearance of spatially circumscribed, sleep-­like
episodes (1–8 Hz) that determine behavioral errors when occurring
in task-­related brain areas. Such episodes likely reflect functional fa-
tigue and sleep need. Given these premises, we hypothesized that
local sleep-­like episodes occurring within prefrontal cortical areas
may represent the physiological link between insufficient sleep and
emotion regulation failures.
Methods: In two distinct experimental visits, nineteen healthy sub-
jects (26 ± 3 yrs, 10F) were presented with amusing video-­clips and
asked either to suppress their facial reactions (emotion suppression,
ES) or to freely express emotional responses (free expression, FE).
An actigraph was worn for 7-­days and used to determine sleep-­time
before each experiment. Facial-­view video and high-­density (hd)
EEG (64-­electrodes) were continuously recorded during the tasks.
Changes in facial expression were identified and manually marked on
the video recordings. Continuous hd-­EEG recordings were preproc-
essed using standard approaches to reduce artifactual activity and
source-­modeled using sLORETA. The signal power in delta (1–4 Hz)
and theta (4–8 Hz) frequency-­bands was computed for four-­second-­
long data epochs immediately preceding the onset of changes in
facial expression. Paired t-­tests were used to compare ES and FE
conditions.
Results: Twelve subjects had at least one emotion suppression fail-
ure in the ES condition. Relative to FE, changes in facial expression
during ES were preceded by local increases in delta (1–4 Hz) activity
in prefrontal, anterior cingulate and left-­parietal regions (p < 0.05,
cluster-­
based correction). Moreover, shorter sleep duration the
night prior to the ES experiment correlated with the number of emo-
tion suppression failures (p = 0.01) and tended to be associated with
higher frontal delta activity during emotion suppression failures
(p = 0.05).
Conclusions: The present results demonstrate that the occurrence
of local, sleep-­like episodes affecting brain areas related to emo-
tional regulation may represent the direct cause of emotion sup-
pression failures. Our results offer a neurophysiological explanation
for previous reports linking sleep loss and alterations of emotional
self-­regulation.
Disclosure: Nothing to disclose.
P15 | Age-­related differences in sleep-­
dependent prospective memory consolidation
R. Leong; J.C. Lo; M. Chee
Centre for Sleep and Cognition, Yong Loo Lin School of Medicine,
National University of Singapore, Singapore, Singapore
Objectives/Introduction: Existing literature suggests that memory
consolidation during sleep is impaired in older adults but may be
preserved for personally relevant information. Prospective memory
(PM) involves remembering to execute future intentions in a timely
manner and has behavioural importance e.g., remembering to take
medication on time. As previous work suggests that N3 sleep is
important for PM in young adults and particularly so for intentions
comprising related cue-­action pairs (Leong et al., 2019), we inves-
tigated if the role of N3 sleep in PM consolidation would be main-
tained in older adults.
Methods: Forty-­nine young adults (mean age ± SD: 21.8 ± 1.61 years)
and 49 healthy older adults (mean age ± SD: 65.7 ± 6.30 years) were
randomized into sleep and wake groups. After a semantic catego-
rization task, participants encoded intentions comprising 4 related
(‘phone-­unplug earphones’) and 4 unrelated (‘mirror-­close the book’)
cue-­action pairs. They were instructed to remember to perform
ABSTRACTS
these actions in response to cue words presented during a second
semantic categorization task 12 h later that encompassed either a
period of daytime wake (09:00–21:00) or overnight sleep with PSG
(21:00–09:00).
Results: We found that the sleep benefit on related PM intentions
varied according to age group (condition x age group x relatedness,
F = 6.707, p = 0.01). While sleep versus wake benefited the execu-
tion of related (but not unrelated) intentions in young adults (YA:
sleep versus wake, related: p < 0.001, unrelated: p = 0.29), sleep
did not improve PM in older adults for either type of intention (OA:
sleep versus wake, related: p = 0.29, unrelated: p = 0.10). Moreover,
whereas post-­encoding N3% was significantly associated with the
execution of related intentions in young adults (r = 0.43, p = 0.03),
this relationship was not found for older adults (r = −0.07, p = 0.763).
Conclusions: We found that the age-­related impairment of sleep-­
dependent memory consolidation extends to PM. Our findings add
to an existing body of work suggesting that the link between sleep
and memory is functionally weakened in later adulthood.
Disclosure: Nothing to disclose.
P16 | Whole-­brain profiling of neuronal
and microglial activities behind inflammation-­
mediated sleep phenotype
K. Kon1; T. Mano2,3; E.A. Susaki1,3; H.R. Ueda1,2,3
1
Department of Systems Pharmacology; 2Department of Information
Physics and Computing, The University of Tokyo, Tokyo; 3Laboratory
for Synthetic Biology, Center for Biosystems Dynamics Research,
RIKEN, Osaka, Japan
Objectives/Introduction: Whole-­brain imaging can allow us to ex-
amine the properties of the brain under certain experimental condi-
tions in a broad and unbiased manner. Our group has developed a
platform to identify and quantify cells expressing target proteins in
the whole-­brain level.
Activation of the immune system triggers several physiological re-
sponses, including drowsiness. Administration of lipopolysaccharide
(LPS) can activate the immune system to mimic a systemic infection.
To explore the relationship between inflammation-­mediated sleep
phenotype and neuronal/microglial activities, we analyzed the ex-
pression of c-­Fos and Iba1 in LPS-­treated mice in the whole-­brain
level.
Methods: Sleep phenotyping was conducted for 4 days under the
12-­hr light/dark condition. On the fourth day, 8-­week-­old mice re-
ceived an i.p. injection of LPS in 150 µg/kg at ZT14.
For the whole-­brain c-­Fos expression analysis, 150 µg/kg of LPS
was injected to 8-­week-­old mice at CT14 under the constantly dark
condition. Mouse brains were collected 1−2 hr after injection (CT15-­
16). For the whole-­brain Iba1 expression analysis, 1 mg/kg of LPS
was injected to 8-­week-­old mice at ZT4. The brains were fixed and
|
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dissected 24 hr after injection. The collected brains were cleared and
stained using CUBIC-­L /R+ and CUBIC-­HistVIsion methods.
Results: We confirmed that administration of LPS acutely induced
drowsiness and hence caused prolonged sleep duration in mice
(n = 4; p < 0.01; Welch's t-­test). We also found that LPS administra-
tion caused the decrease of c-­Fos expression in the cerebral cortex,
whereas the expression was increased in some specific brain nuclei
(n = 4; Welch's t-­test). In addition, the signal intensities of Iba1 were
increased in the cortex by LPS administration, while no significant
change in the Iba1-­positive cell density was observed (n = 7; Welch's
t-­test).
Conclusions: Here we demonstrated the capability that whole-­brain
profiling can provide potential links between sleep-­wake behavior
and neuronal/microglial activities. Our whole-­brain c-­Fos expression
analysis suggests that the acute activation/suppression of specific
brain regions might be involved in the LPS-­induced sleep phenotype.
Furthermore, the Iba1 expression profile implies that the activa-
tion of microglia might be also concerned with LPS-­induced sleep
phenotype.
Disclosure: We thank S. Tomita for supporting sleep measurements
and C. Shimizu for helping sample preparations. COI: E.A.S. and
H.R.U. have filed patent applications for the CUBIC techniques. Part
of this study was done in collaboration with Olympus Corporation.
P17 | Effects of sleep deprivation on birdsong
performance in adult Australian magpies
J. Gaviraghi Mussoi1; R.D. Johnsson2; F. Connelly2,3; J.A.
Lesku2; K.E. Cain1
1
School of Biological Sciences, University of Auckland, Auckland, New
Zealand; 2School of Life Sciences, La Trobe University; 3School of
BioSciences, The University of Melbourne, Melbourne, VIC, Australia
Objectives/Introduction: Birds sing to attract mates, defend territo-
ries, manage hierarchies, and signal danger or food to conspecifics.
Among songbirds, song is learned through imitation and sensorimo-
tor processes, a complex behaviour very similar to human language.
Song learning and maintenance occur through song repetition during
the day, and consolidation during sleep. However, little is known re-
garding whether (and how) lack of sleep affects song performance in
adult birds. In this study, we investigated whether whole-­night sleep
deprivation altered the song performance of Australian magpies
(Cracticus tibicen).
Methods: We deprived adult magpies (n = 8) of a full night of sleep
(12 h) through gentle handling. We recorded their songs the day
before sleep loss (baseline), the day following the night-­time sleep
deprivation protocol (treatment), and the day after an undisturbed
night of sleep (recovery). We used generalized linear models and lin-
ear mixed-­effect models to determine whether treatment and time
of day influenced the probability of singing and song parameters.
 |
78 of 356       ABSTRACTS
Results: We found that sleep-­deprived magpies sang longer songs
(t = 3.560, p < 0.001), but sang less frequently (z = −4.151, p < 0.001).
This reduction in the amount of song output continued after recov-
ery sleep (z = −2.874, p < 0.05), but song length returned to base-
line levels (t = 0.724, p > 0.05). After sleep deprivation, birds also
shifted their usual peak singing times, singing more songs during
the afternoon instead of in the morning and evening. Moreover,
after the recovery night, birds sang at a lower bandwidth than ob-
served in baseline (z = −10.252, p < 0.001) or treatment (z = −11.652,
p < 0.001).
Conclusions: Sleep-­deprived birds may prioritize sleep over singing;
however, they could also overcompensate by singing longer songs
and shifting to mid-­day vocalizations, possibly to improve territory
protection and hierarchy maintenance, or as a stress response fol-
lowing night-­time disturbance. These findings indicate that sleep
can have large effects on ecologically relevant behaviours, includ-
ing singing in adult songbirds. Further work should look at spectral
features of bird song following extended periods of wakefulness for
added insight into how sleep influences the songs of adult birds.
Disclosure: Nothing to disclose.
P18 | Validation of a wearable heart rate and
sleep tracker compared with polysomnography
in police and rescue workers under natural
conditions
B. Stucky1,2; I. Clark1; Y. Azza3,4; S. Müller5; W. Karlen6; P.
Achermann2,7; B. Kleim3,4; H.-P. Landolt1,2
1
Institute of Pharmacology and Toxicology; 2Sleep & Health Zurich,
University Center of Competence; 3Department of Experimental
Psychopathology and Psychotherapy, University of Zurich;
4
Department of Psychiatry, Psychotherapy and Psychosomatics,
University Hospital of Psychiatry Zurich; 5Schutz & Rettung
6
Zurich; Institute of Robotics and Intelligent Systems, ETH Zurich;
7
Department of Psychiatry, Psychotherapy and Psychosomatics, The
Key Institute for Brain-­Mind Research, University Hospital of Psychiatry
Zurich, Zurich, Switzerland
Objectives/Introduction: Commercially available wrist activity and
heart rate (HR) wearables represent an increasingly employed alter-
native to polysomnographic (PSG) sleep recordings. Nevertheless,
their accuracy and reliability are variable and validation in naturalis-
tic studies in populations vulnerable to sleep disturbances, such as
emergency personnel shift workers, is lacking.
Methods: In 52 paramedics and police officers (32.9 ± 7.5 years;
29 female), nocturnal sleep was monitored at home simultaneously
with all-­night PSG and Fitbit Charge 2™. PSG-­derived sleep varia-
bles were scored according to validated criteria. Sleep onset latency
to stages 1 (SO1) and 2 (SO2), sleep duration (SLD), percentage of
wakefulness after sleep onset (WASO) and REM sleep in the first
NREM-­REM cycle (REM%), REM latency (REML), median heart rate
(HR) and absolute deviation (MAD) of HR were estimated with both
measurements. Temporal synchronization between the instruments
was achieved by maximizing cross-­
correlation after cubic spline
interpolation and resampling. Bland-­
Altman plots and Wilcoxon
signed-­rank tests assessed the limits of agreement (LoA) and bias as
mean difference (md).
Results: Fitbit estimated SO2 to occur earlier (p < 0.001, md = 7.4,
LoA = [−68.3, 83.1] min) and REML later (p = 0.023, −29.5 [−145, 85.9]
min) than PSG, possibly reflecting the 34% of missing first REM epi-
sodes. Other variables, including SO1 (−0.3 [−71.3, 71.9] min), SLD
(−1.3 [−164.1, 161.5] min), WASO (−3.3 [−25.2, 18.2] %) and REM%
(−1.6 [−32.9, 29.6] %) did not show a significant difference with PSG.
Analyses of the HR variables confirmed subtle sex-­and age-­related
differences and dynamic modulations across consecutive NREM-­
REM sleep cycles.
Conclusions: The Fitbit criteria for determining sleep variables are
not publicly known. Our data indicate an unbiased estimate of SO1.
Important other sleep characteristics showed no bias with PSG nei-
ther, suggesting that Fitbit-­derived assessments may provide viable
average estimates of sleep quality in a natural setting. Nevertheless,
the large LoA for some variables indicate high, non-­
negligible
variability.
Disclosure: Supported by the Clinical Research Priority Program
‘Sleep & Health’ of the University of Zürich.
P19 | Chemogenetic activation of VGLUT2
neurons in the left nodose ganglion of the vagal
nerve suppresses rapid-­eye-­movement sleep in
mouse
N. Cherrad1; R. Cardis1; A. Osorio-Forero1; M. Arnold2;
L.M.J. Fernandez1; A. Lüthi1
1
Department of Fundamental Neurosciences, Université de Lausanne,
Lausanne; 2SLAAF, ETH Zurich, Schwerzenbach, Switzerland
Objectives/Introduction: Why is our sleep disturbed when our heart
beats rapidly or when our stomach is full or empty? Little is known
about how bodily states, including activity in the gut, in the heart
and in other organs, affect mammalian sleep regulation. The vagal
nerve brings sensory fibers from the autonomic periphery to the
central nervous system with the cell bodies of many of these affer-
ents located in the nodose ganglion. We asked whether stimulating
vagal sensory afferents can modulate sleep.
Methods: Using the VGLUT2-­Ires-­Cre mouse line, nodose ganglia
neurones of the left vagus nerve were injected to express cre-­
dependent fluorescent reporter proteins for histological identifica-
tion of projections in the central nervous system. We then used a
chemogenetic approach to activate VGLUT2 nodose ganglion neu-
rons while performing polysomnographic recordings (EEG/EMG)
after CNO injections (~1 mg/kg i.p.) or NaCl in freely moving mice.
ABSTRACTS
Sleep-­wake behaviour was analysed according to standard proce-
dures (Fernandez et al., Jove 2017).
Results: The anterograde tracing revealed fluorescently labelled sen-
sory projections within the main vagal-­recipient nuclei of the brain-
stem. First results show that chemogenetic activation of the vagal
sensory afferents suppresses rapid-­
eye-­
movement sleep (REMS).
Thus, REMS onset latency in the light phase was increased from
18 ± 2.7 min in NaCl to 56 ± 17 min in CNO (n = 5, p = 0.009, Student's
t-­test). To confirm this change in sleep architecture, we tested the
following polysomnographic characteristics until the first consoli-
dated REMS period. There were no increases in the theta (6–10 Hz)/
delta (0.75–4 Hz) ratio and in gamma power (50–80 Hz) in the power
spectrum. Furthermore, heart rate remained decelerated. Regarding
the spectral composition of NREMS during this period, we found that
sigma power was suppressed (n = 5, p = 2.18e-­4, Student's t-­test ),
whereas delta power (1.5–4 Hz) (n = 5, p = 5.76e-­4, Student's t-­test
) and slow oscillations (0.5–1.5 Hz) (n = 5, p = 0.009, Student's t-­test)
were increased. The spectral composition of wakefulness seemed
unchanged.
Conclusions: Our study reveals that a moderate nodose ganglion
activation has an impact on the architecture and the spectral com-
position of sleep. We propose that altered bodily conditions play an
important role in regulating the occurrence of REMS during natural
sleep.
Disclosure: Nothing to disclose.
P20 | A comparative test of the brain warming
hypothesis for REM sleep
G. Ungurean1,2; B. Barrillot2; D. Martinez-Gonzalez1; P.-A.
Libourel2; N.C. Rattenborg1
1
Avian Sleep Group, Max Planck Institute for Ornithology, Seewiesen,
Germany; 2SLEEP Team, UMR 5292 CNRS/U 1028 INSERM, CNRS –
Centre de Recherche en Neurosciences, Bron, France
Objectives/Introduction: Mammalian REM sleep is associated with
an increase in cortical and sub-­cortical temperature, likely result-
ing from endogenous metabolic heat generated by increased neu-
ronal activity or an increase in blood flow from the warmer body
core to the brain to support this wake-­like activity. Brain warming
might simply be a functionless biproduct of functions that require
increased neuronal activity, such as brain development and certain
types of learning and memory consolidation. Alternatively, it has
been proposed that brain warming is beneficial because it counter-
acts cooling occurring during preceding non-­REM sleep, and thereby
prepares the animal to awaken and rapidly interact adaptively with
the environment. If brain warming is a core function of REM sleep,
then it should also occur during avian REM sleep and a REM sleep-­
like state, characterized by rapid eye movements and increased neu-
ronal activity, in bearded dragon (Pogona vitticeps) lizards.
|
      79 of 356
Methods: Adult pigeons (N = 7) and dragons (N = 4) were surgically
instrumented for recording electrophysiologically defined sleep
states and ‘cortical’ brain temperature. After post-­surgical recovery,
night-­time recordings were obtained from all animals. The pigeon re-
cordings were scored in 1 s epochs for wakefulness, non-­REM sleep,
and REM sleep using standard criteria. The dragon recordings were
scored for non-­REM and REM sleep-­like states following Libourel
et al. (PLoS Biol, 2018).
Results: Across the 12-­h night, the pigeons experienced nearly one
thousand (979.6 ± 100.4) bouts of REM sleep lasting 6 ± 0.6 s. Tbr
decreased during non-­REM sleep and increased during REM sleep.
Longer bouts of non-­REM sleep resulted in greater decreases in Tbr
(rrm = −0.87, 95% CI [−0.93, −0.76], p = 6.4*10−14) and longer bouts
of REM sleep resulted in greater increases in Tbr (rrm = 0.90, 95% CI
[0.79, 0.95], p = 2.9*10−11). By contrast, even though dragons expe-
rienced much longer bouts of the REM sleep-­like state (46 ± 28.9 s),
brain temperature did not increase during this state.
Conclusions: REM sleep in mammals and birds and the REM sleep-­
like state in dragons are all characterized by wake-­like neuronal ac-
tivity. However, this activity is only accompanied by brain warming
in endotherms, suggesting that it serves other functions shared by
endotherms and, at least some, ectotherms.
Disclosure: Nothing to disclose.
P21 | Treating sleep disorders following
traumatic brain injury in adults: time for renewed
effort?
K. Stewart1; N. Shakarishvili1; A. Michalak1; E.L. Maschauer1;
N. Jenkins2; R.L. Riha1
1
Department of Sleep Medicine; 2Edinburgh Medical School, University
of Edinburgh, Edinburgh, United Kingdom
Objectives/Introduction: Fifty percent of people who have suffered
a traumatic brain injury (TBI) have sleep disturbances with 25–29%
subsequently being diagnosed with a sleep disorder. To date, no co-
herent review has been conducted which identifies and discusses
treatment options across all sleep disorders post-­TBI. This system-
atic review aimed to identify all randomised, controlled trials (RCTs)
to date on treatment of sleep disturbances and their effectiveness
in adults post-­TBI.
Methods: Four investigators independently conducted a system-
atic search of multiple electronic databases from February 2020
to April 2020. Studies were selected if they measured changes in
sleep disturbance following a controlled treatment trial in individuals
following TBI. Primary outcomes included, but were not limited to,
insomnia, hypersomnia, obstructive sleep apnoea (OSA), circadian
rhythm disorder (CRD), narcolepsy, periodic limb movement (PLM)
and nightmare disorder. Secondary outcomes included general sleep
disturbances or difficulties. Objectively and subjectively measured
sleep changes were investigated.
 |
80 of 356       ABSTRACTS
Results: Twenty-­four RCTs were included in the meta-­analysis, to-
taling 1183 participants, all of whom had suffered TBI. We identi-
fied treatment trials targeted at specific and well-­described post-­TBI
sleep disorders such as insomnia (n = 6), hypersomnia (n = 5) and
CRD (n = 3). No treatment options to date have been trialed for
specific sleep disorders such as OSA, PLM disorder and parasom-
nia disorders. The majority of treatment trials investigated sleep
symptoms as opposed to specific sleep disorders (n = 9). On aver-
age, subjective measurements were often used and found significant
improvements, however, only 50% of the studies utilised objective
measurements and from those only 50% found significant improve-
ments. Only three studies showed strong correlation between ob-
jectively and subjectively measured improvements; armodafinil for
hypersomnia, blue light therapy for CRD and verum acupuncture for
general sleep disturbance.
Conclusions: While the number of studies identified is low, some of
the studies suggest that common non-­TBI treatments can be applied
with success to a post-­TBI population. The efficacy of a variety of
treatments to improve sleep post-­TBI has shown that only a few,
disparate interventions have demonstrated any efficacy due largely
to small sample sizes and methodological limitations. We have iden-
tified an area of unexplored need in the management of post-­TBI
patients which needs to be urgently addressed.
Disclosure: Nothing to disclose.
P22 | Nocturnal heart rate variability indices
are associated with incident cardiovascular
events in a prospective population-­based cohort
M. Berger1; V. Pichot2; C. Hirotsu1; G. Solelhac1; J. Haba-
Rubio1; F. Roche2; R. Heinzer1
1 P23 | Efficacy of Pitolisant 20 mg in reducing
Center for Investigation and Research in Sleep (CIRS), Lausanne
University Hospital (CHUV), Lausanne, Switzerland; 2SNA-­EPIS
Laboratory, EA 4607, University Hospital of Saint-­Etienne, Saint-­
Etienne, France, Saint-­Etienne, France
Objectives/Introduction: Sleep is a complex homeostatic function
which has an important impact on the autonomic nervous system
regulation. The objective of the present study is to assess whether
nocturnal heart rate variability (HRV), a widely used non-­invasive
tool to evaluate cardiovascular (CV) autonomic control, could predict
incidence of any fatal and non-­fatal CV events 5 years later.
Methods: HypnoLaus is a prospective middle-­
to-­
older-­
age
population-­based cohort in which an ambulatory full polysomnog-
raphy (PSG) and a full clinical work-­up were performed at baseline.
CV profile was assessed at baseline and after a 5-­years follow-­up. A
panel of specialists adjudicated the development of CV events (in-
cluding stroke, myocardial infarction, percutaneous coronary inter-
vention, coronary artery bypass grafting, peripheral artery disease
or CV-­death) following international recommendations. One lead
electrocardiogram from the PSG was exported to the HRVanalysis
software to analyze HRV. An accurate preprocessing was performed
before analyze RR interval and obtain linear and non-­linear HRV in-
dices. Multivariable-­adjusted COX regressions were used for statis-
tical analysis. Results are expressed as hazard ratio (HR) and 95%
confidence intervals for one standard deviation increase for each
HRV parameter.
Results: Of the 1784 participants (48.2% men, 58 ± 11 years) free
of any CV disease at baseline, 67 (3.8%) developed a CV event over
5-­year follow-­up. After adjustment for age, sex, body mass index,
smoking status, depression, hypertension, diabetes, sleep drugs,
beta-­blockers, apnea-­hypopnea index and periodic leg movement
index during sleep, the following HRV indices were independently
associated with the incidence of CV events: root mean square of
successive difference of normal beat-­to-­beat intervals (rMSSD: 0.65
[0.45–0.96]; p = 0.029); High frequency on power spectral density
(HF: 0.51 [0.27–0.97]; p = 0.041); standard deviation of the instan-
taneous beat‐to‐beat variability (SD1: 0.66 [0.45–0.96]; p = 0.031)
deceleration capacity (DC: 0.63 [0.47–0.84]; p = 0.002); acceleration
capacity (AC: 1.59 [1.17–2.16]; p = 0.003); percentage of inflection
point (PIP: 1.41 [1.11–1.78]; p = 0.005); turbulence onset (TO: 0.74
[0.55–0.99]; p = 0.047).
Conclusions: During sleep, low parasympathetic activity (RMSSD;
HF; SD1; DC), high sympathetic activity (AC) and some heart rate
fragmentation indices (PIP; TO) are associated with increased inci-
dent CV events in our population-­based sample. Such HRV param-
eters could be used as non-­invasive biomarkers of CV risk in clinical
practice.
Disclosure: Support: Leenaards Foundation, Faculté de Biologie
et de Médecine de Lausanne, Ligue Pulmonaire Vaudoise, Swiss
National Science Foundation.
excessive daytime sleepiness for patients with
obstructive sleep apnea syndrome: an individual
patient data meta analysis
C. Caussé1; P. Lehert2,3; J.-L. Pépin4; V. Attali5,6; Y.
Dauvilliers7
1
Bioprojet Pharma, Paris, France; 2Faculty of Medicine, University
of Melbourne, Melbourne, VIC, Australia; 3Faculty of Economics,
University of Louvain, Mons, Belgium; 4Grenoble University Hospital,
ADTSAS, Grenoble; 5Sorbonne Université, INSERM, UMRS1158
Neurophysiologie Respiratoire Expérimentale et Clinique; 6AP-­HP,
Groupe Hospitalier Universitaire APHP-­Sorbonne Université, Pitié-­
Salpêtrière, Service des Pathologies du Sommeil (Département R3S),
Paris; 7Neurologie Trouble du Sommeil et de l’Éveil, Montpellier
University Hospital, Montpellier, France
Objectives/Introduction: Pitolisant is an Histamin H3-­
receptor an-
tagonist/inverse agonist waking agent for the treatment of Excessive
Daytime Sleepines (EDS) in adult narcolepsy patient. We synthesized
ABSTRACTS
evidence on its efficacy and safety at a dose of 20 mg compared with
placebo through an Individual patient data meta-­analysis based on the
two studies HAROSA-­1 and -­2 that have included Obstructive Sleep
Apnea (OSA) patients presenting EDS and treated respectively with
and without Continuous Positive Airway Pressure (CPAP) therapy.
Methods: Epworth Sleep Scale (ESS) and Oxford Sleep Resistance
(Osler) tests were co-­primary endpoints tested at 0.025 significance
and Fatigue (Pichot Scale) was secondary. Intent to treat was our se-
lection basis. For sensitivity purpose, three competing meta-­analytical
and three alternative missing data imputation methods were compared.
Results: A significant mean ESS reduction of −2.66 ([95%CI −3.58,
−1.53], p < 0.001) was found with Pitolisant versus placebo and 79%
more patients decreased final ESS to less than 10 (RR = 1.79 [95%CI
1.35, 2.38], p < 0.001). The Osler Final/Baseline was also 16% bet-
ter (ratio = 1.16, [95%CI 1.02, 1.32], p = 0.018). A clinically meaning-
ful EDS effect of Pitolisant measured by the aggregate Z-­score on ESS
and Osler was 0.59 ([0.36, 0.82], p < 0.001). Finally, a significant mean
Pichot Fatigue reduction of −1.231 ([−2.285, 0.177], p = 0.022) was
found. These effects were shown invariant across various subgroups
of the population (age, gender, and work conditions). Finally these ef-
fects were not impacted as to whether or not CPAP was used.
Conclusions: These results provide evidence of significant pitolisant
efficacy on EDS and Fatigue symptoms in sleepy OSA patients ver-
sus placebo, evaluated by the ESS, Osler, EDS Z-­score and Pichot
Fatigue, irrespective of CPAP use.
Disclosure: Bioprojet sponsored this analysis. C Caussé is an employee
of bioprojet pharma. P Lehert received honoraria from bioprojet.
P24 | Hot topic: residual daytime sleepiness
(RES) after obstructive sleep apnea (OSA)
treatment in the European Sleep Apnea Database
(ESADA) study: prevalence and predictors
C. Barbera1; F. Cibella2; O. Marrone2; A. Pataka3; J.
Kvamme 4; H. Hein5; S. Mihaicuta6; J. Hedner7; L. Grote7; J.-L.
Pepin8; M. Bonsignore1,2; On behalf of the ESADA Study
Group
1
PROMISE, University of Palermo; 2IRIB-­CNR, Palermo, Italy;
3
Respiratory Medicine, Aristotle University, Thessaloniki, Greece;
4
Department of ENT, Førde Central Hospital, Førde, Norway;
5
Sleep Disorders Center, Reinbek/Geesthacht, Germany; 6Victor
Babes University of Medicine and Pharmacy, Timisoara, Romania;
7
Department of Sleep Medicine, Sahlgrenska University Hospital,
Gothenburg, Sweden; 8INSERM HP2 (U1042) and Grenoble University
Hospital, University Grenoble Alpes, Grenoble, France
Objectives/Introduction: In patients with OSA treated with continuous
positive airway pressure (CPAP), RES has been insufficiently studied.
Since new pharmacological treatments against RES were recently ap-
proved, the contemporary prevalence and possible predictive factors
of RES in CPAP-­treated OSA patients were investigated.
|
      81 of 356
Methods: Patients on CPAP treatment at first follow-­up visit (V1) were
selected and analyzed for prevalence and correlates of RES. Both ex-
cessive daytime sleepiness (EDS) at baseline and RES were defined as
Epworth Sleepiness Scale (ESS) score ≥10. The following potential pre-
dictors of RES, i.e., anthropometrics, OSA severity at baseline, subjec-
tive sleep time at V1, CPAP adherence (< or ≥4 h), residual AHI (<10/h
or ≥10/h) and comorbidities, were evaluated by multivariate regression
analysis.
Results: In the entire sample (n = 5515), mean ESS decreased from
10.4 ± 5.2 to 6.7 ± 4.8, and prevalence of EDS fell from 56.9% at
baseline to 28.3%, post-­treatment. In subjects with residual AHI data
(n = 2349, baseline mean age 55.2 ± 11.9 yrs, mean BMI 33.4 ± 6.9 kg/
m2, mean AHI 39.2 ± 23.0 events/h), mean ESS decreased from
10.2 ± 5.1 to 8.0 ± 5.0, with prevalence of EDS decreasing from 54.0%
to 35.5%. In this sample, stratification according to CPAP use and re-
sidual AHI revealed no significant differences in prevalence of RES
or other variables among groups. Predictors of ESS at V1 were (R2 of
the model 0.055): male sex (Beta = 0.66 [95%CI 0.10/1.22] p = 0.02),
age (Beta = −0.29 [95%CI −0.05/−0.01] p = 0.006), body mass index
at baseline (Beta =  0.09 [95%CI 0.05/0.12] p < 0.0001), subjective
sleep time (Beta = −0.007 [95%CI −0.010/−0.005] p < 0.0001), and
residual AHI (Beta = 0.06 [95%CI 0.02/0.09] p = 0.002); CPAP adher-
ence correlated directly with ESS at V1. No comorbidity, i.e. coro-
nary artery disease, diabetes, hypertension, psychiatric disorders,
COPD, or insomnia, significantly predicted RES.
Conclusions: RES occurred in over 25% of CPAP-­treated OSA pa-
tients. Predictors of RES were similar to those previously reported
and rather weak, suggesting that RES is a complex clinical challenge
involving other, yet unidentified, factors.
Source of funding: the ESADA project is currently funded by ERS
(Clinical Research Collaboration) and received funding by ResMed,
Respironics and Bayer.
Disclosure: Maria R Bonsignore received consultant fees from
Bioprojet. All other authors referred no conflict of interest.
P25 | Depressive symptoms and daytime
sleepiness are stronger predictors of subjective
cognitive decline than objective cognitive
performance, APOE genotype and subjective
sleep quality in elderly individuals
A. Michalak1; V. Grove2; Z. Shabana1; C. Dietrich2; E.
Mioshi1; A.M. Minihane2; M. Hornberger2; A.S. Lazar1
1
School of Health Sciences, Faculty of Medicine and Health Sciences,
University of East Anglia, Norwich, United Kingdom; 2Norwich Medical
School, Faculty of Medicine and Health Sciences, University of East
Anglia, Norwich, United Kingdom
Objectives/Introduction: Subjective cognitive decline (SCD) is a po-
tential harbinger of prodromal dementia and has been associated
 |
82 of 356       ABSTRACTS
with depressive symptoms and sleep disturbances. Excessive day-
time sleepiness (EDS), is another important risk factor for dementia-­
related cognitive impairment. Elderly individuals with EDS are more
vulnerable to Alzheimer's-­related-­β-­amyloid accumulation. Individuals
at-­genetic-­risk of Alzheimer's (APOE-­ε4+ carriers) are more likely to
develop clinically significant depressive symptoms as well as sleep dis-
turbances while APOE associations with objective and subjective cog-
nitive changes are inconsistent. We aimed to estimate the independent
contribution of APOE genotype, depressive symptoms (Patient Health
Questionnaire-­
9, PHQ-­
9), sleep quality (Pittsburgh Sleep Quality
Index, PSQI), daytime sleepiness (Epworth Sleepiness Scale, ESS) and
objective cognitive performance (Trail making test-­Part B, TMT-­B) on
SCD controlled for age, sex and years spent in education.
Methods: 120 healthy, elderly participants (87 females, age = 65+10;
APOE-­ε4¯ (low risk) n  = 89; APOE-­ε4+(high risk) n = 31) underwent
extensive screening including cognitive assessment, questionnaires
focusing on sleep, sleepiness, circadian typology, physical and men-
tal health, psychological characteristics and APOE genotyping. We
used the Cognitive Change Index (CCI) questionnaire to assess SCD
in memory, executive function and language domains. The tool con-
sists of 20 items with higher scores indicating increased SCD. TMT-­B
measures visual attention and executive functions and is among the
most commonly used instruments sensitive to brain damage. Higher
values indicate worse cognitive performance.
Results: Our multivariate regression model (F = 5.682, p < 0.001,
2
R  = 0.30) tested for multicollinearity returned a significant inde-
pendent effect of PHQ-­9 (β = 0.313, p = 0.003) and ESS (β = 0.202,
p = 0.028) with no significant effect of age (β = 0.038, p = 0.688), sex
(β = −0.092, p = 0.290), genotype (β = −0.108, p = 0.215), years of edu-
cation (β = −0.078, p = 0.363), PSQI (β = 0.073, p = 0.498) and TMT-­B
(seconds)(β = 0.134, p = 0.159). A stepwise regression approach con-
firmed the effects of PHQ-­9 (β = 0.355, p < 0.001) and ESS (β = 0.218,
p = 0.011) but also TMT (β = 0.168, p = 0.042) as a significant predictor
of SDC.
Conclusions: Here, we provide evidence that depressive symptoms
represent the strongest predictors of subjective cognitive decline
followed by daytime sleepiness and objective cognitive perfor-
mance. APOE status and sleep quality are not associated with the
individual's subjective perception of cognitive decline. Our results
allow for a better understanding of the multifactorial nature of self-­
reported cognitive decline associated with ageing and dementia.
Disclosure: Nothing to disclose.
P26 | Excessive daytime sleepiness in Siberian
adolescents with Internet addiction
S. Tereshchenko; N. Semenova; L. Evert; O. Zaytseva; M.
Shubina
Scientific Research Institute of Medical Problems of the North,
Krasnoyarsk, Russian Federation
Objectives/Introduction: Internet addiction (IA) is a relatively new
psychological phenomenon, most marked in socially vulnerable
groups (e.g., in adolescents and young adults). IA is known to be as-
sociated with personal peculiarities, psychosocial characteristics,
and physiological factors. Excessive daytime sleepiness (EDS) is one
of the most common sleep disorders in adolescents associated with
social behavior patterns. We aimed to evaluate the association of IA
with EDS in Siberian adolescents.
Methods: 4637 urban Siberian (Krasnoyarsk, Abakan) school-­based
adolescents (aged 12–18; boys/girl ratio 2215/2422) were tested
with Chen Internet Addiction Scale (CIAS). Based on the CIAS, score
Internet users were categorized into three groups: adaptive Internet
users (AIU) (scoring 27–42); maladaptive Internet users (MIU) (scor-
ing 43–64); and pathological Internet users (PIU) (scoring ≥65). EDS
was assessed by Pediatric Daytime Sleepiness Scale (PDSS); cutoffs
for EDS were PDSS 95% percentiles for each age group (12 y.o. – 20
points, 13 y.o. – 21 points, 14–16 y.o. – 22 points, 17–18 y.o. – 23
points), as it was proposed. Quantitative data are shown as median
(25–75% quartiles). Chi-­square and Kruskal-­Wallis tests were used.
Results: We revealed that EDS prevalence progressively increase
with IA severity: AIU group (n = 2402) – 1.4%, MIU group (n = 1905)
– 3%, and PIU group (n = 330) – 12.4% (pAIU-­MIU = 0.001; pAIU-­
PIU < 0.001; pMIU-­PIU < 0.001). Significant positive association
was detected between IA severity and PDSS score: AIU group –
10 (6–13), MIU group – 14 (10–17), and PIU group – 17 (13–21), p
(K-­W ) < 0.001).
Conclusions: According to our data, EDS is strongly associated with
IA in Siberian adolescents. The possible explanations of this relation
may be:
(1) the higher rate of night activity among Internet overusers,
(2) night sleep disturbances, such as insomnia, and
(3) the presence of common pathogenic factors in IA and EDS, such
as personality characteristics, depression, anxiety.
The reported study was funded by RFBR according to the research
project № 18–29-­2203219.
Disclosure: Nothing to disclose.
ABSTRACTS
P27 | Disturbances of continuous sleep and
circadian rhythms account for behavioural
difficulties in children with Autism Spectrum
Disorder
E. Yavuz-Kodat1; E. Reynaud1; M.-M. Geoffray2,3; N.
Limousin4; P. Franco5,6; F. Bonnet-Brilhault7; P. Bourgin8,9;
C.M. Schröder9,10,11
1
University of Strasbourg/Institut des Neurosciences Cellulaires et
2
Intégratives (CNRS, UPR 3212 INCI), Strasbourg; Department of
Child and Adolescent Neurodevelopmental Psychiatry, Le Vinatier
3
Hospital, Bron; Health Services and Performance Research (HESPER),
Claude Bernard University Lyon 1, Lyon; 4Department of Neurology
and Clinical Neurophysiology, University Hospital Bretonneau, Tours;
5
Pediatric Sleep, Hôpital Femme Mère Enfant, Hospices Civils de
Lyon; 6Lyon Neuroscience Research Center U1028/UMR5292, Claude
Bernard University Lyon 1, Lyon; 7University of Tours/UMR 1253,
iBrain, Inserm, CHRU de Tours, Centre Universitaire de Pédopsychiatrie,
Tours; 8Sleep Disorders Center & CIRCSom (International Research
Center for ChronoSomnology) – Strasbourg University Hospitals;
9
University of Strasbourg/Institut des Neurosciences Cellulaires et
10
Intégratives (CNRS, UPR 3212); University of Strasbourg Medical
11
School; Department of Child and Adolescent Psychiatry, Strasbourg
University Hospitals, Strasbourg, France
Objectives/Introduction: Sleep disorders are among the most com-
mon comorbidities in children with Autism Spectrum Disorder (ASD),
and subjectively defined sleep disturbances have been related to
ASD symptom severity. However, no study has investigated the dif-
ferential impact of both objectively measured sleep and circadian
rhythm disturbances on behavioural difficulties in this population.
Methods: Fifty-­one children with ASD aged 3 to 10 years under-
went assessments of sleep and circadian rest-­activity rhythms ob-
jectively with actigraphy and subjectively with the Children's Sleep
Habits Questionnaire. Behavioural difficulties were assessed using
the Aberrant Behaviour Checklist-­Community. Group comparison
analyses were used to compare sleep and circadian rhythm param-
eters of children with higher and lower behavioural difficulties, and
dominance analysis to rank predictors and address multicollinearity.
Results: Children with high irritability had less continuous sleep by
60 minutes compared to those with lower irritability (p = 0.04), and
those with high stereotypic behavior 75 minutes less compared to
children with less stereotypies (p = 0.006). Both objective circadian
and sleep disturbances accounted together for respectively 17%,
18% and 36% of the variance in social withdrawal, irritability and
stereotypic behaviors.
Conclusions: The identification of both sleep and circadian rhythm
disturbances as explanatory factors for behavioural difficulties war-
rants their inclusion in the existing behavioural management strate-
gies for children with ASD.
Disclosure: Nothing to disclose.
|
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P28 | Insomnia severity and mental health
in the Italian adult population during home
confinement due to Covid-­19 pandemic
V. Bacaro1; M. Chiabudini2; C. Buonanno3; P. De Bartolo1; D.
Riemann4; F. Mancini1,3; C. Baglioni1,4
1
University of Rome Guglielmo Marconi, Rome, Italy; 2iOMEDICO AG,
Freiburg, Germany; 3Scuola di Psicoterapia Cognitiva, Rome, Italy;
4
Department of Clinical Psychology and Psychophysiology/Sleep,
Medicine, Centre for Mental Disorders, University Medical Center,
Freiburg, Germany
Objectives/Introduction: Clinical insomnia has a prevalence of circa
10% in Europe and it is associated with increased stress and negative
health consequences. As Covid-­19 pandemic spread worldwide, Italy
was one of the most affected country and the Italian population was
forced to home confinement from 10th March to May 4th 2020. This
condition exposed most individuals to unprecedented stress, which
may have acted as precipitating factor for acute insomnia. In a cross-­
sectional online survey targeting all adults over 18 yrs old, we aimed
to evaluate changes in prevalence of insomnia and to identify factors
associated with severity of the disorder.
Methods: The study started on March 24th and was concluded on
the May 4th 2020. The Insomnia Severity Index was used as main
outcome. Validated measures of stress, emotion regulation, cogni-
tive flexibility, sleep hygiene, dysfunctional beliefs about sleep,
circadian preference, anxiety, and depression were used. Specific
questions were asked to determine: number of family components,
family status, health habits, use of electronic devices, self-­report
of mental disorders and variables related to the pandemic. A linear
multivariable regression model was used to estimate the association
between the mentioned variables considered as predictors and se-
verity of insomnia as outcome.
Results: The final sample comprised 1989 persons (F:1515; M: 474;
Age: 38.4 ± 12.8 years). Prevalence of clinical insomnia was 18.6%
(higher in the 18–30 age group, with extreme rates in males). The
linear regression model showed that sleep hygiene behaviours
(β = 0.11, 95% CI = 0.07–0.14) and dysfunctional beliefs about sleep
(β = 0.09, 95% CI = 0.08–0.11) are significantly associated with se-
verity of insomnia. Moreover, self-­reported mental disorder was
significantly associated to insomnia severity (β = 2.51, 95% CI = 1.8–
3.1). Finally, results showed a significant role of anxiety (β = 0.33,
95% CI = 0.25-­0.42) and depression (β = 0.24, 95% CI = 0.16–0.32)
symptoms as predictors of insomnia severity.
Conclusions: Preliminary data indicate an alarming increase of
the prevalence of clinical insomnia in the Italian population during
home confinement. Results of the regression model suggest that
psychoeducational preventive interventions on sleep and insomnia
may be associated with effective reduction of insomnia severity.
Furthermore, patients with anxiety and depression may benefit for
clinical therapy for insomnia disorder.
Disclosure: Nothing to disclose.
 |
84 of 356       ABSTRACTS
P29 | Higher polygenic risk for insomnia
is associated with lower delta power during
habitual sleep in young individuals without sleep
disorders
E. Koshmanova1; V. Muto1,2; M. Jaspar1,2; C. Meyer1,2; D.
Chylinski1; M. Grignard1; G. Hammad1; C. Berthomier3; M.
Brandewinder3; A. Luxen1; C. Degueldre1; E. Salmon1,4,5;
C. Phillips1,6; F. Collette1,4; D. Posthuma7; M. Georges8; C.
Schmidt1,4; P. Maquet1,2,5; E. Van Someren9; G. Vandewalle1
1
GIGA-­Cyclotron Research Centre-­In Vivo Imaging, University of
Liège, Liege; 2Walloon Excellence in Life sciences and Biotechnology
(WELBIO), Wallonia, Belgium; 3PHYSIP, Paris, France; 4Psychology
and Neurosciences of Cognition (PsyNCog) Unit, University of Liège;
5 Zucconi2; L. Ferini Strambi1; V. Castronovo2
Department of Neurology, University Hospital of Liège; 6GIGA-­In
Silico Medicine, University of Liège, Liège, Belgium; 7Vrije Universiteit
Amsterdam, Amsterdam, The Netherlands; 8GIGA-­Medical Genomics,
9 Neurology – Sleep Disorders Center, Milan, Italy
University of Liège, Liège, Belgium; Netherlands Institute for
Neuroscience NIN – KNAW, Amsterdam, The Netherlands
Objectives/Introduction: Insomnia is the most common sleep disor-
der. Yet, its treatment remains difficult. A full understanding of the
factors contributing to insomnia is therefore crucial to design novel
efficient strategies. Here, we assessed whether genome-­wide poly-
genic risk score (PRS) for insomnia is associated with sleep in young
healthy adults devoid of any sleep complaints.
Methods: Electroencephalography (EEG) was recorded during habit-
ual night-­time sleep in 456 healthy volunteers (mean age 22 ± 2.68,
range 18–31 years, 49 females). Validated automatic procedures
were used for sleep staging and arousal and artefact detection prior
to fast Fourier transformation and cumulated power extraction in
different frequency bands. Individual liability for insomnia was esti-
mated using the 23 and Me summary statistics of an insomnia case-­
control study (N = 944.477). Generalized linear mixed models were
used to test potential links between six sleep features of interest (as
dependent variables) and PRSs for insomnia, controlling for sex, age
and BMI (as well as total sleep time when relevant). Sleep features of
interest included sleep onset latency, wake after sleep onset, rapid
eye movement (REM) sleep duration, slow wave energy (SWE, cumu-
lated overnight power in the delta frequency band during non-­REM
(NREM) sleep – 0.5–4 Hz) and cumulated NREM power in the beta
band (16–25 Hz).
Results: Analyses revealed a significant association between SWE
and PRS for insomnia (p = 0.003, β  =  −0.16). This association was
mainly driven by delta oscillations in the faster range (1.25–4 Hz,
p = 0.001, β  =  −0.16). SWE was also significantly associated with
sex (p < 10−9, β = −0.28) and age (p = 0.008, β = −0.15). Exploratory
analyses further showed that PRS was also associated with NREM
theta power (4.25–7.75 Hz) (p = 0.002, β = −0.13) but not with alpha,
sigma or beta power during NREM sleep, nor with slow rhythm
power (2-­6 Hz) during REM sleep.
Conclusions: These results show that slow wave sleep intensity can
be associated with insomnia liability in healthy young individuals
without sleep disorders. They suggest that individual ability or need
to generate slow waves during sleep is related to the risk of develop-
ing insomnia. The low power in slow waves could be interpreted as
a marker of altered sleep homeostasis that had been previously sug-
gested as a contributing factor for insomnia.
Disclosure: Nothing to disclose.
P30 | Insomnia subtypes and efficacy of
cognitive-­behavioral therapy
M. Sforza1; A. Galbiati1; C. Leitner1; A. Filice1; F. Casoni2; M.
1
Faculty of Psychology, ‘Vita-­Salute’ San Raffaele University; 2IRCCS
San Raffaele Scientific Institute, Department of Clinical Neurosciences,
Objectives/Introduction: Insomnia disorder (ID) is characterized
by high degree of heterogeneity, that might influence treatment re-
sponse. The aim of our study was to identify ID patients subtypes
in terms of sleep and non-­sleep related clinical features at baseline
(BL) as well as Cognitive-­Behavioral Therapy for Insomnia (CBT-­I)
outcomes.
Methods: 294 chronic insomnia patients (61.6% female, mean age
40.7 ± 12.3 yrs) underwent 7-­sessions group CBT-­I. Using latent class
analysis (LCA) we identified ID subtypes according to baseline (BL)
scores of the following scales: Glasgow Sleep Effort Scale (GSES),
Epworth Sleepiness Scale (ESS), Dysfunctional Beliefs and Attitudes
about Sleep (DBAS-­
16), Morningness-­
Eveningness Questionnaire
Self-­A ssessment (MEQ-­SA), Perceived Stress Scale (PSS), Profile of
Mood States (POMS), Beck Depression Inventory (BDI-­II), Stay-­Trait
Anxiety Inventory (STAI-­Y ) and Treatment effectiveness (Insomnia
Severity Index Delta score, ISI BL – ISI end of treatment, END).
Results: We chose 3 latent classes as most parsimonious model.
According to questionnaires’ cut-­
off, and therefore clinical sig-
nificance of the symptoms, we labeled three classes: Class 1 (only
Insomnia) (n = 79), Class 2 (Insomnia+Anxiety) (n = 153), Class 3 (In
somnia+Anxiety+Depression+Stress) (n = 62). The variables that
best differentiate the 3 classes were POMS (0.772), STAY (0.660),
PSS (0.545), BDI (0.406) and ISI (0.228) at BL. In particular, for ISI,
the best item predicting groups differentiation was item 3, which
investigates the impact of insomnia on daytime functioning (0.224).
Though, at the END, the largest percentage of responders (ISI de-
crease ≥8) was found in Class 3 (63.5%), the same subtype showed
highest percentage of patients with clinical depression (29.2%).
Moreover, we found a significant interaction between CBT-­I treat-
ment effect (indices pre-­post treatment) and the classes member-
ship at: ISI score (p = 0.001), GSES score (p = 0.002), DBAS score
(p < 0.05), PSS score (p < 0.001), POMS score (p < 0.001), BDI score
(p < 0.001) and STAI-­Y score (p < 0.001).
ABSTRACTS
Conclusions: Our data driven analysis suggests that the heterogene-
ity of ID patients can be best represented by non-­sleep scores, in
particular those regarding depression, anxiety, stress and daytime
functioning. These information can be useful in predicting the out-
come of CBT-­I both on sleep and non-­sleep symptoms.
Disclosure: Nothing to disclose.
P31 | Self-­control performance, but not
subjective vigilance level, decreases after brief
periods of task practice and increases following
caffeine intake
G. Avvenuti1; G. Handjaras1; F. Setti1; A. Leo2; L. Cecchetti1;
M. Betta1; E. Ricciardi1; P. Pietrini1; G. Bernardi1
1 Morris2; L. Genzel1
Momilab, IMT School for Advanced Studies Lucca, Lucca;
2 Donders Center for Neuroscience, Radboud University, Nijmegen, The
Department of Translational Research and Advanced Technologies in
Medicine and Surgery, University of Pisa, Pisa, Italy
Objectives/Introduction: Previous work demonstrated that ex-
tended task practice (6 h) leads to performance impairment in dis-
tinct tasks requiring the same cognitive functions (Bernardi et al.,
2015). This effect has been thought to depend on the build-­up of
region-­
specific functional fatigue, with the appearance of local
sleep-­like episodes. Here, we investigated whether similar behav-
ioural changes may occur on a shorter timescale of tens of minutes.
Moreover, we tested whether caffeine-­intake may revert variations
in behavioural performance.
Methods: Nineteen healthy subjects (27 ± 3 yrs, 10F) completed, in
a pseudo-­random order, two experimental visits during which they
either practiced with Stroop-­like tasks requiring self-­control (‘fatigue
condition’, FC), or with similar but simplified tasks that did not re-
quire impulse-­control (‘control condition’, CC). In each visit, partici-
pants completed three 45 min task-­blocks, preceded and followed
by 15 min test-­sessions during which they completed Likert-­type
scales assessing subjective vigilance, mood, perceived effort and
motivation and a Go/NoGo-­test (600 trials, 10% lures) used to track
variations in self-­control. Before the last task-­block, participants
received a caffeinated or a decaffeinated beverage (n = 11, n = 8,
respectively). Performance levels and subjective scores were nor-
malized with respect to the first test-­session (TS-­1). Permutation-­
based approaches were used to test for statistical significance while
controlling for the order of experimental visits.
Results: After 45 min of task-­practice (TS-­2) behavioural perfor-
mance in the Go/NoGo test worsened in FC but not in CC (contrast:
p = 0.034). However, self-­reported vigilance resulted higher in FC
(p = 0.005). No significant differences were found for other subjec-
tive scores. Of note, the effect-­size of differences between FC and
CC tended to decrease after additional 45 min of task practice (TS-­
3), most likely due to a reduction of motivation in CC (p = 0.069).
Caffeine-­intake significantly improved performance in the Go/NoGo
task, independently from experimental condition (TS-­4, p = 0.028).
|
      85 of 356
Moreover, subjective vigilance (p = 0.008) and mood (p = 0.026) in-
creased, while perceived effort decreased (p = 0.017).
Conclusions: Present results indicate that even brief periods of
practice with impulse-­
control tasks are sufficient to induce per-
formance impairment, in spite of subjectively high vigilance levels.
Furthermore, we showed that caffeine does improve self-­control re-
gardless of prior levels of brain functional fatigue, probably through
its positive effects on vigilance and attention.
Disclosure: Nothing to disclose.
P32 | Allocentric vs egocentric memory in rats
and humans: effects of sleep
A. Samanta1; J. Jacobse2; J. Rossato2; R. Schoenfeld3; R.
1
Netherlands; 2Center for Cognitive and Neural Systems, University of
Edinburgh, Edinburgh, United Kingdom; 3University of Halle, Halle,
Germany
Objectives/Introduction: It has been shown that hippocampal-­led
replay during sleep leads to subsequent improvements in memory
and hippocampus has also been shown to be crucial for spatial navi-
gation. It is thus interesting to see the differential effects of sleep on
allocentric (hippocampal) vs egocentric (striatal) memory conditions.
Methods: Rats were first trained on the water maze under either
allocentric or egocentric condition. In the allocentric condition, they
had a different starting location to find the platform, whereas in
the egocentric condition, the starting location remained the same
throughout. Post training they either had 6 h sleep or sleep depriva-
tion (SD) followed by a probe trial after 24 hours. After probe trial,
retrieval induced immediate early gene expression were measured
in the hippocampus, PFC and striatum. Analogously a virtual water
maze was developed to train humans under both conditions. They
were initially trained on the task in the MRI scanner under either
allocentric or egocentric condition, followed by a short nap or movie
and later tested with a probe trial in the scanner.
Results: Rats (n = 40) from both training conditions performed sig-
nificantly above chance level (p < 0.05). However, those trained
under allocentric condition, showed a significant improvement
(p < 0.05) in memory performance after sleep compared to the sleep
deprived condition. Performance in the egocentric condition was in-
dependent of sleep effects. Following sleep they showed increased
levels of c-­fos, ARC and zif in all three brain areas for both train-
ing conditions. SD rats, however, showed increased expression only
in the hippocampus and striatum under allocentric and egocentric
conditions respectively. In humans, however, participants who took
a nap showed a significant improvement in memory independent
of training condition. (n = 77, p = 0.014). Analogously, preliminary
MRI findings in humans show an activation of regions in the Default
Mode Network during training and a shift to activation of cortical
 |
86 of 356       ABSTRACTS
regions during test session, only in the sleep condition (p < 0.05
uncorrected).
Conclusions: Overall, we show sleep to have an improved memory
effect across both models. IEG expression analyses and MRI find-
ings indicate that sleep leads to a whole brain systems consolida-
tion, which potentially is the underlying reason behind the improved
memory effects.
Disclosure: Nothing to disclose.
P33 | Association between daytime rest, night-­
time sleep and hippocampal integrity in healthy
older adults
M. Baillet1; M. Reyt1,2; M. Deantoni1; A. Lesoinne1; S.
Laloux1; E. Lambot1; C. Berthomier3; M. Brandewinder3; E.
Salmon1,2,4; B. Evelyne1; C. Phillips1,5; C. Bastin1,2; V. Muto1;
G. Hammad1; S. Christina1,2
1 P34 | Heritability of sleep traits: a systematic
GIGA-­Institute, Cyclotron Research Center/In Vivo Imaging;
2
Psychology and Neuroscience of Cognition Research Unit, Faculty
of Psychology and Educational Sciences, University of Liège, Liège,
Belgium; 3Physip SA, Paris, France; 4Department of Neurology,
University Hospital of Liège; 5GIGA-­In Silico Medicine, University of
Liège, Liège, Belgium
Objectives/Introduction: The interaction between the circadian
timing and wake-­dependent homeostatic processes provides hu-
mans with a temporal alternation between consolidated periods of
sleep and wakefulness across the 24-­h cycle. Napping is a prevalent
behavior in older individuals and represents an intrusion of sleep
into the wakefulness period, potentially leading to a disruption of
the sleep-­wake cycle. Here, we assessed the association between
daytime naps and night-­time sleep macro-­and microstructure, as
well as their relationships with hippocampal integrity as a sensitive
marker of brain aging.
Methods: Daytime rest was measured through actigraphy (≥10 con-
secutive days; threshold: 15 min of consecutive rest) in 48 healthy
older adults (69 ± 5.9 years, 43% female). In-­lab polysomnography
assessments were used to derive night-­time sleep parameters, in-
cluding total sleep time, sleep stages duration (N1-­N3 and REM; %
of total sleep time), slow wave activity during N3 and spindle density
during N2. High-­resolution T2-­weighted images were used to derive
hippocampal subfields (CA1, CA2, CA3, dentate gyrus, subiculum)
using the Automatic Segmentation of Hippocampal Subfields al-
gorithm. Myelin content in these different subfields was assessed
using quantitative magnetization transfer saturation mapping on a
subsample of 39 participants. Acquisitions were performed on a 3T
magnetic resonance scanner.
Results: Generalized linear models adjusted for age and sex re-
vealed that daytime rest periods were negatively related to N3
(R2β* = 0.093, p = 0.038) and slow wave activity (R2β* = 0.097,
p = 0.034) and positively associated with N2 (R2β* = 0.089, p = 0.043)
and spindle density (R2β* = 0.121, p = 0.017). Spindle density was
further negatively associated with myelin content within the CA1
subfield (R2β* = 0.108, p = 0.046).
Conclusions: Our results suggest that daytime rest goes along with
decreased N3 and slow wave activity. This result may be interpreted
as an altered homeostatic sleep pressure build-­up as a cause or a
consequence of daytime napping. The concomitant positive asso-
ciation between daytime rest, N2 and sleep spindle density might
reflect a compensatory mechanism by which night-­time sleep con-
tinuity is maintained despite altered sleep need. However, higher
spindle density was related to lower myelin content within CA1 sub-
region. Mediation analyses will be performed to assess whether nap-
ping alters hippocampal integrity through sleep structural changes.
Disclosure: The authors have no conflict of interest to disclose.
Sources of funding: Belgian Fund for Scientific Research (FNRS),
European Research Council (ERC-­Starting Grant).
review and meta-­analysis
D. Kocevska1; N.L. Barclay2; W. M. Bramer3; P. Gehrman4;
E.J.W. van Someren5,6,7
1
Netherlands Institute for Neuroscience, an Institute of the Royal
Netherlands Society for Arts and Sciences, Amsterdam, The
Netherlands; 2Department of Clinical Neurosciences, Sleep and
Circadian Neuroscience Institute (SCNI), University of Oxford,
Oxford, United Kingdom; 3Medical Library, Erasmus MC University
Medical Center, Rotterdam, The Netherlands; 4Perelman School
of Medicine, University of Pennsylvania, Philadelphia, PA, United
States; 5Department of Sleep and Cognition, Netherlands Institute for
Neuroscience; 6Department of Psychiatry, Amsterdam Neuroscience
Research institute, Amsterdam UMC, Vrije Universiteit; 7Department
of Integrative Neurophysiology, Center for Neurogenomics and
Cognitive Research, Amsterdam Neuroscience, Vrije Universiteit,
Amsterdam, The Netherlands
Objectives/Introduction: Epidemiological and interventional re-
search has highlighted sleep as a potentially modifiable lifestyle be-
havior associated with both physical and mental health. Emerging
evidence from (behavioral) genetic research shows that sleep char-
acteristics are under strong genetic control. We aimed to pool the
literature in this area to quantify the heritability of sleep duration,
sleep quality and insomnia symptoms in the general population.
Methods: We conducted a systematic literature review in 5 online
databases on February 20th 2019, which was updated to search for
additional items on January 24th 2020. Two authors independently
screened 5,767 abstracts, and 160 complete articles for the inclusion
criteria of twin studies from the general population reporting herit-
ability statistics on sleep duration, quality and/or insomnia, written
in English. We ultimately included 19 independent samples for sleep
duration (50,046 twins, aged 6 months-­88 years), 9 for sleep quality
ABSTRACTS
(34,848 twins aged 16–95 years), and 11 for insomnia (47,494 twins
aged 8–88 years).
Results: We showed that 46% of the interindividual variability in
sleep duration, 44% of sleep quality and 40% of insomnia symp-
toms is genetically influenced. The remaining variation in the sleep
characteristics can mostly be attributed to the unique environment,
although the shared environment played a role for childhood sleep
duration. Moderation analyses showed that the heritability of sleep
quality and insomnia symptoms is similar across age and sex, though
results varied by assessment method for insomnia symptoms. The
heritability estimates of sleep duration were lowest in infancy and
young childhood (20%), highest in adolescence (70%) and decreased
in adulthood (40%). Sleep duration heritability estimates were
highest for actigraphically measured sleep duration (92%), moder-
ate for self-­reported (41%) and diary reports (52%), and lowest for
parent-­reported (12%) and polysomnographic sleep duration (10%).
Heritability estimates for insomnia symptoms were highest for
parent-­reported symptoms (72%) compared to self-­reported (37%)
and clinician rated (46%).
Conclusions: Our findings highlight the importance of considering
genetic influences when aiming to understand the mechanisms con-
tributing to the trajectories of sleep patterns across the lifespan.
Differences in heritability estimates across age and assessment
method assessment could impact future sleep research and infer-
ences drawn from it.
Disclosure: The authors have no conflicts of interest to disclose. The
work was funded by NWA Startimpuls Royal Netherlands Academy
of Arts and Sciences 2017 Grant (AZ/3137) and by the European
Research Council grant ERC-­2014-­AdG-­671084 INSOMNIA.
P35 | Clinical and polysomnographic
comparison between excessive dreamers and
healthy controls
C. Krämer; J. Cataldi; F. Siclari
Centre of Investigation and Research on Sleep, Lausanne University
Hospital and University of Lausanne, Lausanne, Switzerland
Objectives/Introduction: Epic dreaming disorder (EDD) is a condi-
tion in which patients complain of excessive and relentless dream-
ing throughout the night that leaves them feeling tired the next day.
Although regularly encountered in clinical practice, it is poorly docu-
mented, and there is no effective therapeutic solution.
Methods: Here, we investigated clinical characteristics of 18 EDD
patients and 18 healthy gender-­and age-­
matched controls (HC)
through semi-­structured interviews and questionnaires. 8 EDD pa-
tients and 12 HC also underwent a high-­density EEG sleep record-
ing. Wilcoxon signed-­rank tests were used to compare variables
between the groups, and a Bonferroni correction was applied to ac-
count for multiple comparisons (p-­values are corrected unless speci-
fied otherwise).
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      87 of 356
Results: EDD patients were predominantly women (88.9%) aged
35.2 ± 8.0 (mean ± SD). The disorder was lifelong in 33.4% and
chronic in the remainder of patients (mean duration 8.5 ± 7.0 years).
Major associated complaints included excessive daytime sleepiness
(7 patients), insomnia (3 patients), and important fatigue (18 pa-
tients). Five patients (27.8%) fulfilled the diagnostic criteria for hy-
persomnia. 38.9% of patients suffered from chronic pain. Compared
to HC, EDD patients scored significantly higher on the Epworth
Sleepiness Scale (11.3 ± 5.7 vs 5.4 ± 2.9 points, p = 0.046), the
Fatigue Severity Scale (49.4 ± 8.2 vs 25.3 ± 8.5 points, p = 0.002) and
indicated poorer sleep quality (PSQI 7.6 ± 2.8 vs 3.0 ± 1.6 points,
p = 0.006). In questionnaires on dreaming, EDD patients reported
more frequent dream recall than HC, more nightmares, as well as
dreams that were more tiring (p < 0.05). EDD patients displayed less
wake after sleep onset during the sleep recording compared to HC
(15.9 ± 9.9 min, vs 31.3 ± 23.6 min, p = 0.036 uncorrected). The other
polysomnographic parameters did not differ significantly between
groups.
Conclusions: Our results suggest that EDD is associated with diurnal
hypovigilance, as indicated by higher sleepiness and fatigue scores
and a concomitant diagnosis of hypersomnia in a fourth of patients.
Future assessments should try to determine if sleepiness and exces-
sive dream recall are causally related in EDD patients.
Disclosure: Nothing to disclose.
P36 | Impact of menstrual cycle phase,
progesterone and oral contraceptives on sleep
and overnight memory consolidation
C.P. Plamberger1; H. Van Wijk 2; H. Kerschbaum1; B. Pletzer1;
G. Gruber3; K. Oberascher1; M. Dresler2; K. Hoedlmoser1
1
University of Salzburg, Salzburg, Austria; 2Radboud University,
Nijmegen, The Netherlands; 3The Siesta Group Vienna, Vienna, Austria
Objectives/Introduction: Sleep spindles benefit declarative memory
consolidation and are discussed to be a biological marker for gen-
eral cognitive abilities. However, the impact of sexual hormones and
hormonal oral contraceptives (OCs) on these relationships are less
clear. Women taking OCs show decreased levels of endogenous pro-
gesterone, but increased levels of synthetic progestins compared to
women with a natural menstrual cycle. Progesterone level vary along
the female menstrual cycle, with low levels of progesterone during
the follicular phase (day 1–14), and a peak in progesterone level dur-
ing the mid-­luteal cycle phase (at day 21 in a 28-­day cycle). Our aim
was to investigate the influence of endogenous progesterone and
OCs on sleep spindle density and declarative memory consolidation.
Methods: Nineteen healthy women using OCs (M = 21.4,
SD = 2.1 years) were compared to 43 healthy women with a natural
menstrual cycle (follicular phase: n = 16, M = 21.4, SD = 3.1 years;
luteal phase: n = 27, M = 22.5 SD = 3.6 years). Sleep spindle density
(polysomnography) and sexual hormones (salivary samples) were
 |
88 of 356       ABSTRACTS
measured during two nights (adaptation, experimental). A word-­pair
association task preceding the experimental night followed by two
retrieval tasks (pre-­sleep and post-­sleep) were performed to test de-
clarative memory performance.
Results: Memory performance was improved after sleep for women
using OCs (p = 0.001) and women during the luteal phase (p = 0.001)
of the menstrual cycle. No differences in memory consolidation
were found between the three groups (p > 0.5). Interestingly, fast
sleep spindle density was lower for women with a natural menstrual
cycle in the follicular (low progesterone-­) phase (n = 27) compared to
women in the luteal (high progesterone-­) phase (n = 16) (p = 0.023)
or OC users (p = 0.017). Endogenous progesterone level (pg/ml) in
naturally cycling women (n = 43) was positively correlated with fast
sleep spindle density on frontal (F3: p = 0.024) and central electrode
sites (C3: p = 0.040).
Conclusions: Results suggest a positive influence of endogenous
and synthetic progesterone on fast sleep spindles. Since GABAergic
thalamic reticular neurons plays a crucial role in sleep spindle gen-
eration and progesterone metabolites effect GABA A receptors,
we hypothesize progesterone-­metabolites to increase sleep spindle
density. Neither the use of OCs nor the menstrual cycle phase or
endogenous progesterone level have an effect on sleep-­dependent
memory consolidation.
Disclosure: This was not an industry supported study. None of the
authors has any financial conflict of interest. Georg Gruber is em-
ployee and shareholders of The Siesta Group. This study was funded
by the Centre for Cognitive Neuroscience.
P37 | ‘Real life’ coffee intake in genetically
caffeine sensitive individuals attenuates
neurobehavioural impairments caused by chronic
sleep restriction
D.M. Baur1; D. Lange2; E.-M. Elmenhorst2; D. Elmenhorst2;
A. Bauer3; D. Aeschbach2; H.-P. Landolt4
1
Institut for Pharmacology and Tox|Human Sleep Psychopharmacology,
Universität Zürich, Zürich, Switzerland; 2Department of Sleep and
Human Factors Research, German Aerospace Center, Cologne;
3
Institute of Neuroscience and Medicine, Forschungszentrum Jülich,
4
Jülich, Germany; Department of Sleep and Human Factors Research,
Universität Zürich, Zürich, Switzerland
Objectives/Introduction: Chronic sleep restriction increases sleepi-
ness and impairs neurobehavioral performance. Coffee and its
major psychoactive ingredient, caffeine, is frequently consumed
to counteract these disabling repercussions of inadequate sleep.
Nevertheless, the efficacy of ‘real life’ coffee consumption in prevail-
ing conditions of chronic sleep restrictions is unknown. In addition,
differences in response to caffeine have been linked to functional
polymorphisms in the ADORA2A gene. We investigated the efficacy
of regular coffee intake to improve cognitive abilities during chronic
sleep restriction in genetically caffeine sensitive healthy volunteers.
Methods: We subjected 26 healthy C/C-­allele carriers of ADORA2A
to 5 nights of 5 hours of sleep, followed by 8-­hours recovery sleep.
Regular (400 g at breakfast and 200 g after lunch; 100 ± 1 mg caf-
feine per 200 g fluid; n = 12) and decaffeinated coffee (n = 14) were
administered in randomized, double-­blind manner on all days follow-
ing sleep restriction. Four times each day, participants completed vali-
dated questionnaires and performed psychomotor vigilance test, visual
search task, and visuo-­spatial and letter n-­back tasks. Caffeine and
metabolites were quantified in saliva. Data were analyzed with linear
mixed-­effects models and post-­hoc general linear hypotheses testing.
Results: The two groups did not differ on demographic variables in-
cluding age, BMI, sex-­ratio, chronotype and mood states. Caffeine
and metabolite levels in saliva confirmed that the decaffeinated cof-
fee contained negligible amounts of caffeine. Subjective sleepiness
increased and performance on all tasks deteriorated in both groups
during sleep restriction. Subjective sleepiness did not differ between
the two groups. Nevertheless, regular coffee attenuated the impact
of repeated sleep restriction on speed and/or accuracy on all tasks
when compared to decaffeinated coffee (‘group’ x ‘day’ interaction:
pall < 0.001). The differences between the groups depended on the
task, cognitive load and study day, and disappeared after the recov-
ery night and ceased caffeine administration.
Conclusions: We conclude that ‘real life’ coffee consumption can at-
tenuate sleep restriction-­induced impairments in neurobehavioral
performance in genetically caffeine sensitive individuals. This effect
may not be subjectively perceived.
Disclosure: This research was supported by the Institute for Scientific
Information on Coffee, a not-­for-­profit organization devoted to the
study and disclosure of science related to coffee and health.
P38 | Pre-­and postsynaptic effects of hypocretin
(orexin) on excitatory transmission in layer V
pyramidal neurons of murine premotor cortex
G. Colombo1; A. Coatti1; A. Vassalli2; A. Becchetti1
1
Biotechnology and Biosciences, University of Milano-­Bicocca, Milano;
2
Biomedical Sciences, University of Lausanne, Lausanne, Italy
Objectives/Introduction: Hypocretins (HCRTs) are synthesized
and released by hypothalamic neurons that mainly discharge dur-
ing active waking, and regulate sleep-­to-­wake transitions. During
wakefulness, HCRT neurons set the level of neocortical activation
in response to environmental, physiological or emotional drives.
Besides innervating the subcortical arousal nuclei, HCRT cells also
send direct projections to the neocortex. Although innervation is
dense in prefrontal regions, little is known about the distribution and
physiological roles of hypocretin receptors HCRTR1 and HCRTR2.
We focus on frontal area 2 (Fr2) a premotor region involved in goal-­
oriented behavioral tasks that require immediate attention.
ABSTRACTS
Methods: The effect of HCRT-­1 on excitatory postsynaptic currents
(EPSCs) was studied by voltage-­clamping (−68 mV) layer V pyramidal
neurons in brain slices from young adult mice (>P45), at 34°C. These
neurons constitute the main output channel to subcortical structures.
Results: HCRT-­1 (up to 500 nM) had no effect on Vrest and firing prop-
erties (spike width, threshold, frequency; after-­
hyperpolarization
peak; adaptation), but increased the spontaneous EPSC frequency
(e.g., 11.5 ± 3.5 Hz, control; 14.3 ± 3.6 Hz, 100 nM HCRT-­1; p < 0.05;
paired t-­test; n = 6). SB-­334867 (HCRTR1 antagonist) blocked HCRT-­
1's effect (EPSC frequency: 13.6 ± 2.5 Hz, control; 12.1 ± 2.3 Hz,
1 µM SB-­334867 alone; 11.37 ± 2.39 Hz, 100 nM HCRT-­1 + SB-­
334867; NS, paired t-­test between SB-­334867 and HCRT-­1 + SB-­
334867, n = 5). To distinguish pre-­and postsynaptic effects, we
analyzed miniature EPSCs (mEPSCs) in presence of 1 µM TTX.
HCRT-­1 scarcely affected mEPSC frequency. To test whether the
action of HCRT-­1 on glutamatergic terminals was weakened by the
absence of action potential firing, we enhanced spontaneous neu-
+
rotransmitter release by depolarizing the cells with [K ]o = 20 mM.
In these conditions, 50 nM HCRT-­1 brought mEPSC frequency from
28 ± 4.5 to 46 ± 4.2 Hz (p˂0.01; paired t-­test, n = 16) and their am-
plitudes from 9.7 ± 0.7 to 10.7 ± 0.8 pA (averages of median values;
p˂0.05; paired t-­test, n = 16).
Conclusions: HCRTR1 activation sustains activity in Fr2 layer V by
stimulating glutamate release. The effect may be accompanied by
regulation of post-­synaptic glutamate receptors, but not by modula-
tion of intrinsic cell excitability. This mechanism may contribute to
modulate local θ rhythm, which relies on pyramidal neuron activity,
and is thought to be regulated by hypocretin input.
Disclosure: Work supported by Italian MIUR (FAABR 2018 to AB),
University of Milano-­Bicocca (FAR 2018-­2019 to AB), Swiss National
Science Foundation (grant 31003A_182613 to AV). GC and AC were
supported by PhD fellowships from University of Milano-­
Bicocca
(DIMET Program).
P39 | It's about time: resting during daytime
alters attention in the aged
1,2 1 1
M. Reyt ; M. Deantoni ; A. Lesoinne ; M. Baillet ; E. 1
Lambot1; S. Laloux1; V. Muto1; G. Hammad1; C. Schmidt1,2
1
GIGA-­CRC in Vivo Imaging; 2Psychology and Neurosciences of
Cognition Research Unit, University of Liège, Liège, Belgium
Objectives/Introduction: Sleep-­wake cycle fragmentation has been
associated with cognitive decline in aging. Here, we assessed the
association between attention performance and the distribution of
rest-­activity over the 24-­hour cycle in healthy older adults. We hy-
pothesized a time-­of-­day-­dependent association, such that keeping
a continuous activity level during daytime and a consolidated bout
of rest during night-­time are both beneficial for age-­sensitive atten-
tional performance.
|
      89 of 356
Methods: Forty-­nine healthy older participants (69 ± 5.9 years, 21
women) performed a cognitive test battery including several meas-
ures of attention performance that were compiled in a composite
performance score. Concomitantly, actimetry data were collected
during at least 11 days. Rest-­activity cycle profiles were first ex-
plored by extracting previously reported indices characterizing
24-­hour cycle fragmentation (intra-­daily variability (IV), inter-­daily
stability (IS), state transition probability during daytime (kAR) and
night time (kRA), as well as general confounding variables (average
daily activity and total rest during night time). Stepwise regression
analyses were conducted to determine the contribution of these
actimetry-­derived indices on attention performance, taking into ac-
count age, sex, education level and body mass index. Finally, aver-
age daily rest-­activity profiles were extracted for each participant.
They were sampled over one-­hour bins and realigned on the average
activity onset time of each individual. The association between the
daily rest-­activity profile and attention composite was assessed by
using one-­dimensional statistical parametric mapping (SPM).
Results: Stepwise regression on classical actimetry indices revealed that
besides age, sex, IS and average daily activity, wake fragmentation as
assessed by kAR explained significant part of variance in performance
(R2 = 0.2354, p < 0.01) with lower attention performance associated to
higher state transition probability during daytime (t = −2.431, p < 0.05).
SPM analyses more specifically revealed that higher activity surround-
ing a period of 5 hours after activity onset time was significantly associ-
ated with better attention performance (p < 0.01).
Conclusions: Our data corroborate an association between sleep-­
wake cycle fragmentation and age-­
sensitive attentional perfor-
mance. These results highlight that consolidated bouts of activity
during daytime, particularly during the time window encompassing
the classical napping period, is positively linked to attentional per-
formance in the aged.
Disclosure: The authors have no conflict of interest to disclose.
Sources of funding: Belgian Fund for Scientific Research (FNRS),
European Research Council (ERC-­Starting Grant).
P40 | Testing the performance of an
electrocardiogram-­based sleep staging algorithm
using reflective photoplethysmography data in a
sleep disordered population
B.M. Wulterkens1,2; M.M. van Gilst1,3; P. Fonseca1,2; M.
Radha1,2; M. Ross4; A. Moreau4; A. Cerny4; P. Anderer4; X.
Long1,2; J.P. van Dijk1,3; S. Overeem1,3
1
Eindhoven University of Technology; 2Philips Research, Eindhoven;
3
Sleep Medicine Centre Kempenhaeghe, Heeze, The Netherlands;
4
Sleep and Respiratory Care, Home Healthcare Solutions, Philips
Austria GmbH, Vienna, Austria
Objectives/Introduction: Consumer sleep trackers based on reflec-
tive photoplethysmography (PPG) are becoming increasingly popular
 |
90 of 356       ABSTRACTS

in the general population. However, research validating these de-
vices on clinical populations is limited. To perform automatic sleep
staging, numerous approaches use heart rate variability (HRV). Most
literature describes the use of HRV derived from electrocardiogram
(ECG), mainly due to the availability of large polysomnography (PSG)
datasets including ECG. The aim of this study is to test an ECG-­based
sleep staging algorithm on raw PPG-­signals.
Methods: We used a recently developed sleep staging algorithm
based on long short-­
term memory (LSTM) recurrent neural net-
works, trained on ECG-­derived inter beat intervals (IBIs) from healthy
sleepers and sleep disordered patients. We validated the algorithm
on a hold-­out set comprising 389 recordings of patients with various
sleep disorders, using PSG sleep stages scored according to AASM
criteria as reference. The algorithm was applied separately on IBIs
obtained from ECG and from wrist-­worn reflective PPG, together
with body movements computed from a three axial accelerometer.
Results: The PPG classifier achieved moderate agreement for sleep-­wake
classification (κ of 0.57, accuracy 87.8%) and substantial agreement for
three-­class sleep staging (κ of 0.62, accuracy 81.4%) with PSG. A signifi-
cant difference in performance was found for four-­class sleep staging be-
tween ECG and PPG for both kappa (ECG κ = 0.60 versus PPG κ = 0.56,
p < 0.001) and accuracy (ECG 75.9% versus PPG 73.0%, p < 0.001).
Conclusions: Using ECG-­
trained algorithms, PPG-­
based four-­
class
sleep staging yielded moderate agreement with gold standard PSG.
This opens opportunities for long-­term sleep monitoring, even in a
clinical population, highlighting the potential of this unobtrusive tech-
nology. The decrease in performance relative to the ECG-­based model
might be resolved by retraining the network with PPG data, emphasiz-
ing a need for large PSG datasets with concomitant reflective PPG data.
Disclosure: At the time of writing, PF, MR, MR(2), AM, AC, PA and
XL were employed and/or affiliated with Royal Philips, a commercial
company and manufacturer of consumer and medical electronic de-
vices, commercializing products in the area of sleep diagnostics and
sleep therapy. Philips had no a role in the study design, decision to
publish or preparation of the manuscript.
nightshift work for physicians is daytime somnolence and reduction
of alertness, which can increase risk of medical errors. The objec-
tive of our multicenter study was to assess the prevalence, and the
determinants of daytime somnolence in Italian hospital physicians.
Methods: Within the multicenter PRESOMO study we recruited for
study 268 physicians from hospitals in Cagliari (University Hospital,
N = 57), Milan (San Carlo Borromeo Hospital, N = 180), and Pisa
(University Hospital, N = 31). 196 physicians were night shift work-
ers. Each participant filled two questionnaires, the Italian Association
of Sleep Medicine (AIMS) ‘questionnaire for the evaluation of alertness
for the occupational medicine’, enquiring into sleep habits and sleep
disturbances (presence of sleep disorders, perceived sleep quality,
and satisfaction with sleep) and shift work (working hours, type of
rotation schedule, individual habits after shifts), and the Epworth
Sleepiness Scale (ESS) for the evaluation of daytime somnolence.
We used unconditional regression models to explore the associa-
tion between personal characteristic, lifestyle habits, and history
of nightshift work with poor sleep quality and daytime somnolence.
Results: Age, female gender, taking medication interfering with sleep and
an elevated ESS score were significant predictors of poor sleep quality.
Night shift work was associated with unrestful sleep (OR = 2.4, 95% CI
1.18–5.05) and dozing at daytime (OR = 1.9, 95% CI 1.03–3.64), with a
positive upward trend by years of nightshift work for both conditions (p-­
value 0.043 and 0.017, respectively) and by number of nightshifts/years
for unrestful sleep (p-­value 0.024). Obesity was a risk factor for daytime
somnolence (OR = 5.5, 95% CI 1.94–15.4) and it was consistently associ-
ated with an increase in risk for the other adverse sleep outcomes.
Conclusions: After adjusting for multiple cofactors our findings confirm
that working on night shifts, and particularly years of shift work and num-
ber of nightshifts/years, are significant determinants of perception of
insufficient sleep and daytime somnolence. These results might provide
clues about factors affecting shift work adaptation among hospital phy-
sicians, in order to reduce its impact on their performances and health.
Disclosure: Nothing to disclose.

P42 | Uptake of digital cognitive behavioural

P41 | Prevalence of sleep disturbance and
determinants of sleepiness in a cohort of Italian
hospital physicians: the PRESOMO Study
1 2 3 1
R. Lecca ; E. Battaglia ; M. Maestri ; M. Figorilli ; G. Gioi ; P.
Congiu1; F. Meloni4; E. Bonanni3; P. Cocco 4; M. Puligheddu1
1
Interdepartmental Sleep Research Centre, University of Cagliari,
Cagliari; 2Department of Pneumology, Sleep Medicine Centre,
ASST Santi Paolo e Carlo PO San Carlo Borromeo, Milan; 3Section
of Neurology, Department of Clinical and Experimental Medicine,
University of Pisa, Pisa; 4Unit of Occupational Medicine, Department of
Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
Objectives/Introduction: About 60% Italian healthcare workers
are engaged in nightshift work. One of the main consequences of
therapy for insomnia – changes in response to
COVID-­19
A. Gardiner; N. Stanley
1
Sleepstation.org.uk, Newcastle, United Kingdom
Objectives/Introduction: There is an abundance of evidence that
Cognitive Behavioural Therapy for insomnia (CBT-­I) is effective in
the treatment of insomnia, and is now widely recommended as the
first-­line treatment. Despite the desirability of CBT-­I, it has been re-
ported that there are numerous barriers, both from the physician
and the patient perspective, regarding the uptake of CBT-­I. With the
increase in remote consultations during Covid-­19, we investigated
the uptake of digital Cognitive Behavioural Therapy for insomnia
(dCBT-­I) platform in response to the COVID-­19 lockdown.
ABSTRACTS
Methods: Sleepstation, a clinically proven dCBT-­
I platform with
human support, investigated the take up of their platform when it
was offered free to 3103 UK citizens before and after lockdown in
the UK.
Results: From two comparable 6 week periods
Six months before lockdown (23rd September – 15th November
2019)
1407 offered support
30% (418) took up the offer
75% (312) engaged in the programme
88% (274) positive outcome
During the first 6 weeks of lockdown (23rd March – 15th May 2020)
1696 offered support
71% (1321) took up the offer
72% (939) engaged in the programme
288 completed to date
84% (242) positive outcome to date
Demographics – 76% female, 34% male, 18–89 age range – mean
age 46.
Conclusions: The COVID-­19 pandemic has resulted in a fundamen-
tal change in the traditional way of interacting with a doctor and
of receiving treatment, with many routine consultations being done
remotely. Digital CBT-­I is ideally placed to reduce the time and costs
involved in treating insomnia. However improving access to CBT-­I
provision, either face to face or digitally is only the first step as our
research has shown. Further research needs to be carried out to elu-
cidate the factors that affect initiation, retention and completion of
dCBT-­I both from the Doctors and patients perspective. However,
our data show that the uptake of digitally delivered CBT-­I may indi-
cate a ‘normalisation’ of the role of the online services, at least in the
treatment of insomnia. It may be that the use of digital technologies
has become the new normal in this sphere of sleep medicine.
Disclosure: Both authors work for Sleepstation.org.uk.
P43 | Prevalence of sleep disorders in the adult
population of Armenia: an epidemiological
study
S. Khachatryan1,2,3; L. Ghahramanyan1,4; A. Stepanyan1; A.
Darabyan1; M. Isayan1; H. Hovakimyan1,4; G. Yeganyan1; L.
Vardanyan1,2,4; Z. Tavadyan1,2,3; J. Ulfberg5
1
Armenian Sleep Disorders Association; 2Department of Neurology and
3
Neurosurgery, National Institute of Health; Somnus Neurology Clinic;
4
Sleep Disorders Center, Somnus Neurology Clinic, Yerevan, Armenia;
5
Circad Health, Nora, Sweden
Objectives/Introduction: Sleep disorders are an important public health
problem causing many health and social complications to those affected.
Studying the prevalence of sleep disorders carries some difficulties, as
they are encountered at different rates; they are frequently ignored,
considered normal, acceptable, or benign. Until recent years nearly no
|
      91 of 356
information on the prevalence of sleep disorders in Armenia was avail-
able, except for a telephone survey on restless legs syndrome (RLS).
Armenia has a mostly monoethnic population, who are locals, mainly at-
tached to their land for centuries. We aimed to study the sleep patterns
and prevalence of sleep disorders in the Armenian population.
Methods: The study was held at four different sites considering geo-
graphic latitude and altitude differences characteristic of Armenia. One
urban (capital) area and three rural locations were chosen to meet this
goal. It was a door-­to-­door interview-­based study, volunteers with clinical
background were trained by sleep experts to conduct a 27-­point ques-
tionnaire developed by the research team. These included questions
on sleep time and duration, sleep hygiene-­related factors (caffeinated
beverages, smoking, alcohol and late food intake). Presence of insomnia
(differentiating between sleep-­onset/SOI, sleep-­maintenance/SMI and
early-­
morning awakening phenotypes), snoring, witnessed breathing
stops/BS and leg movements in sleep/LMS, excessive daytime sleepi-
ness (EDS), paralyzed awakenings, vivid dreams and possible enactment,
sleepwalking, and the first four essential criteria for RLS diagnosis were
asked (IRLSSG). Objective measurements included neck and waist cir-
cumferences, finger pulseoxymetry. Additional information on frequent
co-­morbidities and sleep while driving was obtained.
Results: Overall, 1001 adult participants were involved (mean age
– 45.3, females – 67.5%). The mean sleep duration was 6.7 hours.
Frequent use of alcohol, smoking and caffeinated beverages was re-
ported by 7.4%, 19.5% and 66% respectively, while 61.5% reported
late food intake. The frequency of sleep symptoms and disorders
follows with respective percentages: insomnia-­52.6% (F > M), SOI-­
36.6%, SMI-­4 4.2%, snoring-­36.8% (M > F), breathing stops-­22.9%
(F = M), EDS-­39%, RLS-­15% (F > M), LMS-­18%, sleep paralysis-­7.7%,
sleepwalking-­3.3%, tiredness-­45.2%.
Conclusions: Sleep disorders are very prevalent in the Armenian popu-
lation with insomnia, sleep-­disordered breathing, RLS, and some other
sleep disturbances representing a serious threat. The obtained knowl-
edge will serve as an important source for future research in this field.
Disclosure: Nothing to disclose.
P44 | Sleep and physical activity before and
during incremental covid-­19 mobility restrictions
J.L. Ong1; T.Y. Lau1; S. Massar1; Z.T. Chong2; B. Ng2; D.
Koek 2; W. Zhao2,3; B.T.T. Yeo1,4,5; K. Cheong2; M. Chee1
1
Centre for Sleep and Cognition, National University of Singapore;
2
Health Promotion Board; 3Centre for Quantitative Medicine,
Duke-­NUS Medical School; 4Department of Electrical and Computer
Engineering, National University of Singapore; 5N.1 Institute for
Health, National university of Singapore, Singapore, Singapore
Objectives/Introduction: Adequate sleep and physical activity (PA) are
critical to multiple aspects of health and wellbeing. Mobility restrictions
imposed to contain the spread of COVID-­19 are effective in contain-
ing contagion but interfere with habitual routines that orchestrate time
 |
92 of 356       ABSTRACTS
to wake-­up, commute to work, organize meals, socialize, exercise and
wind down to sleep. In this study, we examine how pandemic-­associated
movement restrictions shift sleep and physical activity patterns from pre-
viously established baselines in a sample of Singaporean office workers.
Methods: Wearable data from 1824 city-­dwelling, working adults
aged 21–40 years, incorporating 206,381 nights of sleep and
334,038 days of PA covering baseline, incremental movement re-
striction and lockdown periods (Jan-­Apr 2020), and an equivalent
period in Jan-­Apr 2019, were used to examine how sleep, PA and
resting heart rate parameters changed surrounding key COVID-­19
events. Four distinct rest activity rhythms (RAR) were also identi-
fied using k-­means clustering of participants’ temporally distributed
step counts. Hierarchical clustering of the proportion of time spent
in each of these RAR revealed 4 groups who expressed different
mixtures of RAR profiles before and during the lockdown.
Results: Gradual changes were observed from baseline to incremental
movement restriction periods but the lockdown abruptly shifted sleep
and PA patterns. Substantial but asymmetric delays in bedtime (+27 min)
and waketime (+48 min) during the lockdown resulted in a 21 min in-
crease in overall sleep duration with no loss in sleep efficiency. Resting
heart rate declined ~2 bpm. PA dropped an average of 38%. Hierarchical
clustering techniques revealed an ‘Inactive’ group comprising ~51% of
the sample, who were younger and predominantly single. Habitually less
active already, this group showed the greatest reduction in PA during
lockdown (p < 0.001) and a loss of dominant RAR rhythms. The other
3 groups maintained dominant rhythms during the lockdown, although
they still exhibited increases in sleep duration and decreases in total
steps and resting heart rate (ps < 0.05).
Conclusions: Lockdown had the largest effect on PA and sleep. Sleep
and resting heart rate unexpectedly improved. RAR evaluation un-
covered heterogeneity of responses and can identify characteristics
of persons at risk of decline in health and wellbeing.
Disclosure: Nothing to disclose.
P45 | Oximetry-­derived predictors of atrial
fibrillation in patients with obstructive sleep
apnea
M. Blanchard1,2; C. Gervès-Pinquié3; M. Feuilloy1,2; M.
Le Vaillant3; W. Trzepizur4,5; N. Meslier4,5; A. Paris6; T.
Pigeanne7; J.-L. Racineux3; F. Balusson8; E. Oger9; J.-M.
Girault1,2; F. Gagnadoux4,5
1
ESEO, Angers; 2LAUM, UMR CNRS 6613, Le Mans; 3Pays de la Loire
Respiratory Health Research Institute, Beaucouzé; 4Department of
Respiratory and Sleep Medicine, Angers University Hospital; 5INSERM
Unit 1063, Angers; 6Department of Respiratory Diseases, Le Mans
General Hospital, Le Mans; 7Respiratory Unit, Pôle Santé des Olonnes,
Olonne sur Mer; 8Rennes University, Rennes University Hospital, EA
7449 (Pharmacoepidemiology and Health Services Research) REPERES;
9
Rennes University Hospital, EA 7449 (Pharmacoepidemiology and
Health Services Research) REPERES, Rennes, France
Objectives/Introduction: We hypothesized that indices of oxygen
desaturation and pulse rate variability (PRV) derived from nocturnal
oximetry could predict the onset of atrial fibrillation (AF) in patients
investigated for obstructive sleep apnea (OSA).
Methods: Data from a large multicenter cohort of AF-­free patients
investigated for OSA were linked to health administrative data to
identify new-­onset AF. Cox proportional-­hazards models were used
to evaluate the association between AF incidence and oximetry-­
derived indices automatically generated from sleep recordings.
Results: After a median [inter-­quartile range] follow-­up of 5.34 [3.3–
8.0] years, 181 of 7,205 patients developed AF. After adjusting for
confounders, AF risk was associated with increasing nocturnal hy-
poxemia (p-­trend = 0.02 for quartiles of % recording time with oxy-
gen saturation <90% [T90]) and PRV (p-­trend <0.0001 for quartiles
of root mean square of the successive normal-­normal beat interval
differences [RMSSD]), and decreasing sympathetic/parasympathetic
tone (p-­tend = 0.0004 for quartiles of low frequency/high frequency
[LF/HF]). The highest risk of AF was observed in patients with the
highest quartiles of both T90 and RMMSD compared to those with
neither of these conditions (adjusted hazard ratio [95% confidence
interval]: 3.45 [2.03–5.87]).
Conclusions: In patients investigated for OSA, nocturnal hypoxemia
and PRV indices derived from single-­channel pulse oximetry are in-
dependent predictors of AF incidence. Patients with both marked
nocturnal hypoxemia and high PRV are at higher risk of AF.
Disclosure: FG reports grants and personal fees from RESMED,
personal fees and non-­
financial support from SEFAM, personal
fees from CIDELEC, personal fees and non-­financial support from
NOVARTIS, personal fees from ACTELION, non-­financial support
from BOEHRINGER INGELHEIM, personal fees and non-­financial
support from AIR LIQUIDE SANTE, non-­
financial support from
ASTEN, outside the submitted work; MB, CGP, MF, MLV, WT, NM,
AP, TP, JLR, FB, EO and JM declare no conflicts of interest.
ABSTRACTS
P46 | Autosomal Dominant Cerebellar Ataxia
with Deafness and Narcolepsy (ADCA-­DN):
clinical and polysomnographic follow up of 4
Italian kindreds
E. Postiglione1; E. Antelmi2,3; F. Pizza1,2; E. Mignot4; G.
Plazzi1,2
1
Department of Biomedical and Neuromotor Sciences, University
of Bologna; 2IRCCS Institute of Neurological Sciences, Bologna;
3
Neurology Unit, Movement Disorders Division, Department of
Neurosciences, Biomedicine and Movement Sciences, University of
Verona, Verona, Italy; 4Department of Psychiatry and Behavioral
Sciences, Stanford University School of Medicine, Stanford University
Center for Sleep Sciences, Palo Alto, CA, United States
Objectives/Introduction: DNMT1 gene mutations have been as-
sociated with two autosomal dominant degenerative diseases with
multi systemic involvement including central and peripheral nerv-
ous system. Narcolepsy with cataplexy is a core feature of the
ADCA-­DN phenotype, however, narcolepsy has been also reported
in Hereditary Sensory and Autonomic Neuropathy (HSAN 1E). We
report the follow up of three Italian ADCA-­DN kindreds already de-
scribed adding a new Italian ADCA-­DN family.
Methods: Seven patients underwent repeated extensive evaluation
encompassing polysomnographic investigations, auditory functions
and peripheral nervous system including skin biopsy, ophthalmologi-
cal studies neurophysiological examination, and cerebrospinal fluid
(CSF) hypocretin-­1 (hcrt-­1) assay. Three patients were reviewed from
clinical records.
Results: The first symptom (30% hypoacusia; 20% excessive day-
time sleepiness (EDS)/cataplexy) arose at a mean age of 31.33 years
(y) (25–43). Cerebellar ataxia, neurosensorial hypoacusia, sensorial
neuropathy, optical atrophy was documented in 7/10 (mean onset
age 38.6 y), in 7/10 (mean onset age 33.6 y), in 4/8, and in 3/7 pa-
tients, respectively. Severe psychiatric comorbidity (4/7 patients)
and cognitive impairment (3/6 patients) appeared later (mean age of
38.8 and of 46.7 y, respectively).
MSLT showed short sleep latency and multiple SOREMPs in 3 and
4 out of 7 patients, while nocturnal polysomnography (PSG) dis-
closed increased periodic limb movements during sleep (PLMS –
42.9%), REM sleep behaviour disorder (RBD – 28.6%), and reduced
sleep efficiency (28.7%) at first evaluation. CSF hcrt-­1 levels were
233.84 ± 7.93 pg/mL, with 2/7 patients around the cut-­off of 110 pg/
mL. Follow up at 5.42 ± 1.14 years revealed increase in cataplexy,
and reduction of sleep efficiency (more clear in younger patients),
sleep figures deterioration, increased limb movements (LM), PLMS
and RBD (more evident in older patients).
Conclusions: Narcoleptic symptoms are the key complaints to seek
neurological consultation in ADCA-­DN. Across disease course, a mul-
tifaceted deterioration of sleep included increased LM, PLMS, RBD
up to a ‘status dissociatus’. CSF hcrt-­1 levels were variably reduced,
|
      93 of 356
confirming the involvement of the hypocretin system within a wide-
spread neurodegeneration.
Disclosure: Nothing to disclose.
P47 | The effectiveness of cognitive behaviour
therapy for insomnia on repetitive negative
thinking: a meta-­analysis
A. Ballesio1; V. Bacaro2; M. Vacca1; A. Chirico1; F. Lucidi1; D.
Riemann3; C. Baglioni2,3; C. Lombardo1
1
Sapienza University; 2University of Rome G. Marconi – Telematic,
Rome, Italy; 3University of Freiburg, Freiburg, Germany
Objectives/Introduction: Repetitive negative thinking (RNT), i.e.,
worry and rumination, is thought to exacerbate and perpetuate in-
somnia in cognitive models. RNT is also a longitudinal precursor of
depression and anxiety, which are often co-­present alongside insom-
nia. Whilst accumulating evidence supports the efficacy of cognitive
behaviour therapy for insomnia (CBT-­I) in reducing depression and
anxiety symptoms, the literature on the effects of CBT-­I on RNT has
never been systematically appraised. Preliminary evidence, how-
ever, suggests that reduction of RNT following CBT-­I may be asso-
ciated with reduction of depression and anxiety. To fill in this gap,
we aimed to conduct a systematic review and meta-­analysis on the
effects of CBT-­I on worry and rumination.
Methods: Pubmed, Medline, Scopus, PsycINFO, Psycharticles, Web
of Science and CINAHL were searched up to October 2019. For each
comparison of CBT-­I condition with a comparator, we calculated
the effect size indicating the difference between the two groups
at post-­treatment (Hedge's g) using maximum likelihood estimator
modelling. The associations between post-­treatment improvements
in RNT and post-­treatment in depression and anxiety were explored
using meta-­regression.
Results: Fifteen randomised controlled trials were included (nCBT-
­I: 551, ncontrol: 507). Results showed moderate-­to-­large effects
of CBT-­I on sleep-­related worry (g  =  −0.71, [95% CI  =  −0.92 to
−0.49], p < 0.0001) and general worry (g = −0.41, [95% CI = −0.75
to −0.07], p = 0.017), but small and non-­reliable effects on rumi-
nation (g = −0.13, [95% C = −1.10 to −0.83], p = 0.784). Moreover,
effect sizes were moderate in magnitude and significant for depres-
sion: (g = −0.38, [95% CI = −0.69 to −0.07], p = 0.015) and moderate
but non-­significant for anxiety (g = −0.42, [95% CI = −0.99 to 0.15],
p = 0.153). No clear evidence was found for an association between
post-­treatment reduction in worry and post-­treatment reduction in
depression (slope  =  0.464, [95% CI  =  −0.13 to 1.05] p = 0.12). No
evidence for publication bias was found (Egger test z-­score 1.50 and
a p-­value of less than 0.135).
Conclusions: Although the literature is small and still developing,
CBT-­I seems to have a clearer and stronger impact on sleep-­related
versus general measures of RNT.
Disclosure: Nothing to disclose.
 |
94 of 356       ABSTRACTS
P48 | Chronotype and insomnia subtypes’
symptoms in adults
M. Miller Mendes1,2; S. Marques1; D. Ruivo Marques2,3; A.
Allen Gomes1,2
1
Faculty of Psychology and Educational Sciences, University of
Coimbra; 2Center for Research in Neuropsychology and Cognitive and
3
Behavioral Intervention, Coimbra; Department of Education and
Psychology, University of Aveiro, Aveiro, Portugal
Objectives/Introduction: Schedules preferences have long been
found to differ between morning (MT) and evening (ET) types. In
this sense, in what concerns insomnia symptoms timing one may
expect sleep-­onset complaints to be more common in ET than MT,
whereas early morning-­awakenings would be more probable in MT
than ET. However, very few empirical studies have examined such
a supposition. This work aimed to analyze the likelihood of associa-
tions between chronotype and symptoms of insomnia subtypes (i.e.
initial versus terminal insomnia). Additionally, we aimed to compare
other sleep patterns between MT and ET (sleep quality, duration and
schedules) and differences in psychological symptoms.
Methods: This research included 584 adults (70% women) from the
community (83.9% daytime workers and 16.1% combining students,
unemployed or retired – shift workers were excluded), between 18
and 63 years-­old (34.94 ± 10.40). They completed the Composite
Scale of Morningness (CSM), Basic Scale on Insomnia Complaints and
Quality of Sleep (BaSIQS), Insomnia Severity Index (ISI), questions
on sleep durations and schedules, and Brief Symptoms Inventory-­18
(BSI-­18). Then, MT (n = 141) and ET (n = 148) types were defined
through CSM by using percentiles 25 and 75, for each age group to
neutralize age effects. The resulting groups showed similar mean age
(35.47 for larks, and 34.63 for owls, p = 0.504).
Results: Differences between MT and ET were found regarding
insomnia subtypes’ symptoms. MT scored higher on the item per-
taining terminal insomnia symptoms (U  =  6555, p  <  0.001) and ET
on items evaluating initial insomnia symptoms (U = 7853, p < 0.001;
U = 7196.5 p < 0.001), with small to medium effect sizes (r coefficients:
−0.337; −0.222; −0.282). No statistically significant differences
were found regarding overall sleep quality (BaSIQS total score). ET
presented greater psychological distress (t(281.03) = 2.79, p < 0.01)
and shorter sleep duration during the week (t(272.128  =  −2.530,
p < 0.05). MT showed earlier bedtimes and risetimes during the week
(t(241.776) = 10.913, p < 0.001; t(228.848) = 8.920, p < 0.001) and on
weekends (t(287) = 4.201, p < 0.001; t(273.342 = 13.941, p < 0.001).
Conclusions: The present results grant empirical support to the rela-
tion between chronotype and insomnia subtypes and also reinforces
the notion that diurnal preference concerns essentially sleep-­wake
timings and not perceived sleep quality nor sleep duration on free
time (unconstrained by social demands).
Disclosure: Nothing to disclose.
P49 | Sleep-­related head jerks: towards a new
movement disorder
R. Lopez1,2; S. Chenini1; L. Barateau1,2; A.L. Rassu1; E.
Evangelista1,2; B. Abril3; J. Fanielle 4; N. Vitello5; I. Jaussent2;
Y. Dauvilliers1,2
1
Centre National de Référence Narcolepsie Hypersomnies, Unité des
Troubles du Sommeil, Service de Neurologie, Hôpital Gui-­de-­Chauliac;
2
PSNREC, Univ Montpellier, INSERM, Montpellier; 3Unité du Sommeil,
CHU Nîmes, Nîmes, France; 4Centre d’Étude des Troubles de l’Éveil
et du Sommeil, CHU Liège, Liège, Belgium; 5Independent Researcher,
Vichy, France
Objectives/Introduction: Sleep-­related head jerks (SRHJ) are often
considered as a physiological motor phenomenon, occurring mainly
during rapid eye movement (REM) sleep. Their clinical relevance and
links with other sleep parameters are unclear. We characterized the
clinical and polysomnographic features of patients with excessive
SRHJ and compare them to healthy controls and patients with iso-
lated REM sleep behavior disorder (iRBD).
Methods: Thirty patients (19 males, 27.5 y.o., 16.0–51.0) with a
REM-­HJ index > 30/hour were identified over a period of five years.
All had a video-­PSG recording to characterize the SRHJ, to assess
associations with other sleep parameters and to quantify phasic and
tonic electromyographic activity during REM sleep, compared with
30 healthy controls and 30 patients with iRBD.
Results: Five among the 30 patients had a primary complaint of in-
voluntary nighttime head movements associated with sleepiness or
non-­restorative sleep. The mean REM-­HJ index was 57.22/h ± 24.42,
a non-­periodic pattern, stable across the sleep cycles with a low
between-­
test variability. REM-­
HJs were often associated with
arousals (65.2%) and leg movements (38.1%) and less with respira-
tory events (9.6%), without association with increased phasic and
tonic electromyographic activities. SRHJ were also found in 36.7%
of controls and 56.7% of iRBD patients, but with a lower index in
REM sleep (0.79/h ± 1.59 and 2.76/h ± 4.57).
Conclusions: Although SRHJ are frequent in the general population
and with uncertain clinical significance, rare severe symptomatic
forms should be individualized and categorized as a new sleep-­
related movement disorder, distinct from RBD and periodic leg
movements.
Disclosure: Nothing to disclose.
ABSTRACTS
P50 | Depressive and anxiety symptoms in
idiopathic REM sleep behaviour disorder
E. Rocío Martín1; R. Wix Ramos2; E. Martín Abad2; L. López
Viñas2; S. Delis Gómez2; J. Pastor Gómez2
1
Clinical Neurophysiolgy; 2Clinical Neurophysiology, Hospital La
Princesa, Madrid, Spain
Objectives/Introduction: Idiopathic REM sleep behaviour disorder
(iRBD) is a parasomnia characterized by abnormal motor manifes-
tations during REM sleep. Several studies suggest that depressive
symptoms are early signs of neurodegeneration in RBD. We have
analysed the presence of mood disorders (MD) in patients with iRBD
and their role in the appearance of neurodegenerative diseases.
Methods: 46 patients diagnosed iRBD between 2014 and 2019 were
included. We analysed they clinical histories, scores on psychologi-
cal tests: Beck depression inventory (BDI-­II), the state-­trait anxiety
inventory (STAI); sleep-­
questionnaires: Epworth Sleepiness Scale
(ESS: no excessive daytime sleepiness ≤ 10) and Insomnia Severity
Index (ISI: no insomnia ≤ 14) and nocturnal polysomnography (PSG-­
N). Follow-­up was performed every 6 months to evaluate the pres-
ence of neurodegenerative diseases. Chi-­square test was used to
compare sleep architecture between groups. Student-­t test (normal
distributions) or Mann-­Whitney (non-­normal distributions) were also
used to comparison. Data were shown as mean ± standard error of
mean (SEM). The significance level was set at p = 0.05.
Results: The mean age was 66.9 ± 1.3 years (35 males/11 females).
Patients were classified into two groups. MD+: 24 patients show-
ing at least one of these feature BDI-­II  ≥  14, STAI  >  75th percen-
tile; and MD-­
: 22 patients. Overall, MD+ showed higher values
for BDI-­II (19.5 ± 1.5/4.9 ± 0.9, p < 001, Mann-­Whitney) and STAI
scores of patients with state anxiety was (32.0 ± 1.8/11.5 ± 1.4,
p < 0.001, Student-­
t); trait anxiety (38.9 ± 2.2/13.8 ± 1.4,
p < 0.001, Student-­t); ESS (10.6 ± 1.2/6.7 ± 1; p = 0.018, Student-­t),
ISI (16.1 ± 0.8/8.0 ± 1.8, p < 0.001, Student-­
t). PSG-­
N param-
eters were: sleep efficiency (78.1 ± 2.1/74.5 ± 2.3), no rapid eye
movement sleep (NREM) latency (24.9 ± 3.8/22.3 ± 5.4, min),
REM sleep latency (139.1 ± 20.3/122.5 ± 12.2), N1 + N2 per-
centage (66.1 ± 3.2/66.1 ± 1.8), slow wave sleep percentage
(17.1 ± 2.3/19.4 ± 2.1), REM percentage (14.7 ± 1.4/25.7 ± 4.4). No dif-
ferences were observed for sleep architecture (Chi-­square test). Six
patients with MD+ (6/24 = 0.25) and two patients MD-­(2/22 = 0.091)
presented Parkinson disease at 20.8 ± 6.2/24.5 ± 6.5 months re-
spectively, after diagnosis as iRBD.
Conclusions: In our study, we found that MD symptoms are frequent
in patients with iRBD (52%) and their presence increase the probabil-
ity to develop synucleinopathies in two years after diagnosis.
Disclosure: Nothing to disclose.
|
      95 of 356
P51 | Nights and days during the COVID-­19
pandemic: a two weeks study on day-­to-­day
associations between subjective sleep quality
and mental complaints
P. Simor1,2; N. Báthori3; B. Polner3; R. Sifuentes-Ortega2;
A. Van Roy4; A. Albajara Sáenz2; A. Luque González5; O.
Benkirane2; T. Nagy1; P. Peigneux2
1
Eötvös University, Institute of Psychology and Education, Budapest,
Hungary; 2Université Libre de Bruxelles (ULB), Brussels, Belgium;
3
Budapest University of Technology and Economics, Budapest,
Hungary; 4KU Leuven, Leuven, Belgium; 5Universidad Autónoma de
Madrid, Madrid, Spain
Objectives/Introduction: The outbreak of the COVID-­19 pandemic
led many countries to introduce measures of home confinement.
Cross-­sectional studies suggested a large increase in the prevalence
of mental health complaints (anxiety and depression) as a reaction
to the pandemic, as well as, a consequence of the drastic changes
of daily routines. Poor sleep quality might be a risk factor contribut-
ing to impaired mental health. Nevertheless, cross-­sectional assess-
ments are prone to retrospective biases, and unable to reveal daily
fluctuations of subjective experiences during extended confinement
conditions. We aimed at examining for two weeks day-­to-­day as-
sociations between sleep disruption and negative daytime experi-
ences, focusing on rumination, psychotic-­like phenomena (unusual
thoughts) and somatic complaints that resemble the symptoms of
the COVID-­19.
Methods: Participants recruited from three European countries
(Belgium, Hungary, and Spain) completed a cross-­sectional question-
naire including demographic variables and psychopathological meas-
ures. A subsample of the respondents (healthy adults living in home
confinement, N = 160) was invited to participate in a two-­week long,
prospective study period, during which they were queried through
an online interface about their sleep quality each morning and about
their daytime experiences in the end of the day. Mixed-­effects mod-
elling was used to examine bidirectional temporal links between
sleep quality and daytime mental health complaints, as well as to
separately analyze these associations between and within individu-
als (trait-­and state-­like effects, respectively).
Results: Sleep disruption during the assessment period was asso-
ciated with increased rumination (p = 0.015), psychotic-­like experi-
ences (p < 0.001), and somatic complaints (p < 0.001). Moreover,
daily fluctuations in sleep disruption were predictive of subsequent
negative daytime experiences. More specifically, poor sleep quality
predicted increased rumination (p < 0.001), psychotic-­like experi-
ences (p < 0.01), and somatic complaints the following day (p < 0.01).
Nonetheless, daytime complaints did not significantly predict sub-
jective sleep quality of the following night.
Conclusions: Sleep disruption and mental complaints exhibited pro-
nounced inter-­and intra-­individual variability during this two week
long study period. Our findings indicate that poor sleep quality is a
 |
96 of 356       ABSTRACTS
risk factor for the experience of rumination, unusual thoughts, and
somatic complaints linked to health anxiety. Improving sleep hygiene
might be a key factor in coping against mental burden during home
confinement.
Disclosure: Nothing to disclose.
P54 | Quantitative aspects of the
Sympatho Vagale Balance reported from 523
polysomnographic recordings
D. Cugy
UHCC Bx, Bordeaux, France
Objectives/Introduction: We systematically integrated the
sympatho-­vagal balance calculation when analyzing the sleep re-
cords. The sympathovagal balance is calculated from the analysis of
the variability of the RR space obtained from the ECG signal. We
relate the results of the calculations to the other sleep parameters
and to the diagnosis made after polysomnography.
Methods: The computation of the sympathovagal balance is carried
out from the computation of the spectral analysis of the RR vari-
ability after analysis by wavelet of the ECG signal. The standard bal-
ance (BSV) is calculated as the LF/(LF + HF) ratio. The high values
correspond to the predominance of the sympathetic tone, the low
values to the vagal tone. The calculation was applied systematically
to all the registrations made over the past two years. The data are
analyzed by age, sex, sleep stage and diagnoses.
Results: The population studied is divided into 255 men, 266 women
and 2 transsexuals. 21% under 35, 28% 35 to 50, 28% 50 to 65, 19% 65
to 80 and 4% above. The mean value of BSV is 0.81, which increases
significantly (increase in sympathetic tone) with age (p < 0.001), is
linked to sex: the mean value is 0.82 for men and 0.795 for women
(p < 0.001). The value is inversely correlated with the total sleep time
(p = 0.02) and mainly with the duration of stage 2 sleep (p < 0001)
and REM sleep (p = 0.003). These results are in accordance with
what is known. The value of BSV is significantly lower in narcoleptic
patients compared to other patients (p < 0.0083. It is also found that
BSV is correlated with the index of reactivity of the pulse wave and
is higher in patients with positional OSAS (p = 0.0086)
Conclusions: The sympathovagal balance is a simple parameter to
calculate from the ECG signal which is known as a predictor of car-
diovascular risk factors, the use of which should be integrated into
the routine analysis of polysopnography.
Disclosure: Nothing to disclose.
P55 | Impact of the EEG montage on the
diagnosis of OSAS when using enhanced
polygraphy (PG+)
P. Escourrou1; Z. Balekji1; C. Berthomier2; P. Berthomier2; J.
Mattei2; M. Brandewinder2; G. Roisman1
1
Antoine-­Béclère Hospital AP-­HP, Clamart; 2PHYSIP, Paris, France
Objectives/Introduction: The Apnea-­Hypopnea Index (AHI) deter-
mined by the ventilatory polygraphy (PG) has a limited validity due
to both the unknown duration of sleep and the non-­consideration
of the non-­desaturating hypopneas when followed by an arousal.
This results in errors in determining the severity of OSAS in many
patients. A previous study showed difference in severity between
polysomnography (PSG) and PG but showed no difference between
PSG and the association of PG with the automatic analysis of a single
EEG channel (enhanced polygraphy, PG+). The aim was to assess the
impact of the EEG montage on this result.
Methods: 50 patients suspected of OSAS had an ambulatory PSG.
Three successive analyses were carried out blindly by 2 somnolo-
gists (S1, S2) i) in PG, ii) in PG+ on the periods of sleep determined
by the automatic single channel analysis ASEEGA (A) including the
arousal detection, and iii) in PSG (AASM scoring rules). The two EEG
montages successively and independently analyzed by A were CzPz
and a frontal lead, Fp2 or F4 according to the recordings. Epoch-­
by-­epoch agreements (concordance and Conger's kappa coefficient,
k) on Wake/Sleep scoring were computed and compared, as well as
AHIs.
Results: Epoch-­by-­epoch agreements in Wake/Sleep scoring were
of 94% (k = .81) between S1 and S2, 95% (.78) between A on CzPz
and expert consensus (S1, S2), and 93% (.72) between A on frontal
and expert consensus. AHIs measurements were i) in PG 21 ± 18 ii) in
PG + 28 ± 22 on CzPz and 28 ± 21 on frontal and iii) in PSG 28 ± 22.
Conclusions: AHIs were similar whether computed either by PG+
using centro-­parietal EEG, or by PG+ using frontal EEG, or by PSG.
The single-­EEG algorithm ASEEGA could be used with a frontal mon-
tage to improve AHI measurement using enhanced polygraphy.
Disclosure: C. Berthomier, P. Berthomier and M. Brandewinder have
ownership and directorship in Physip and are employees of Physip
who owns ASEEGA. Support: PHYSIP, CIDELEC, RESMED.
ABSTRACTS |
      97 of 356

P56 | Deep learning enables sleep staging from monitoring of sleep and help detect otherwise overlooked condi-
photoplethysmogram in a clinical population with tions such as REM-­related OSA and comorbid insomnia.
References:
obstructive sleep apnea suspicion
[1] Sadeh A. Sleep Med Rev. 2011;15(4):259–267.
[2] Delessert A et al. Sleep. 2010;33(12):1687–1692.
H. Korkalainen1,2; J. Aakko3; B. Duce 4,5; S. Kainulainen1,2;
Disclosure: This work was financially supported by the Research
A. Leino1,2; S. Nikkonen1,2; I.O. Afara1,6; S. Myllymaa1,2; J.
Committee of the Kuopio University Hospital Catchment Area for
Töyräs1,2,6
1 the State Research Funding (projects 5041767, 5041768, 5041770,
Department of Applied Physics, University of Eastern Finland;
2 5041776, 5041779, 5041780, 5041781, and 5041783), the Academy
Diagnostic Imaging Center, Kuopio University Hospital, Kuopio;
3 of Finland (decision numbers 313697 and 323536), the Respiratory
CGI Suomi Oy, Helsinki, Finland; 4Department of Respiratory &
Foundation of Kuopio Region, the Research Foundation of the
Sleep Medicine, Sleep Disorders Centre, Princess Alexandra Hospital;
5 Pulmonary Diseases, Foundation of the Finnish Anti-­Tuberculosis
Institute of Health and Biomedical Innovation, Queensland University
Association, the Päivikki and Sakari Sohlberg Foundation, Orion
of Technology; 6School of Information Technology and Electrical
Research Foundation, Instrumentarium Science Foundation, the
Engineering, University of Queensland, Brisbane, QLD, Australia
Finnish Cultural Foundation via the Post Docs in Companies pro-
gram and via the Central Fund, the Paulo Foundation, the Tampere
Objectives/Introduction: Identifying sleep stages accurately is Tuberculosis Foundation, and by Business Finland (decision number
crucial in the diagnosis of various sleep disorders such as ob- 5133/31/2018).
structive sleep apnea (OSA). However, sleep staging still relies on
labor-­intensive, expensive, and time-­consuming manual scoring of
overnight polysomnographic (PSG) recordings. Additionally, long-­ P57 | Validation of an automatic arousals
term assessment of sleep currently relies on actigraphy only ca-
detection method for whole-­night sleep EEG
pable of differentiating between wake and sleep periods without
recordings
identifying specific sleep stages. Furthermore, actigraphy has low
reliability in identifying wake periods after sleep onset and tends to
D. Chylinski1; F. Rudzik 2; D. Coppieters3; M. Grignard1; N.
overestimate the total sleep time, especially when laying awake [1].
Vandeleene1; M. Van Egroo1; L. Thiesse2; S. Solbach2; P.
Photoplethysmogram (PPG) measurement with a simple finger pulse
Maquet1,4; C. Phillips1,5; G. Vandewalle1; C. Cajochen2; V.
oximeter is already included in PSG and ambulatory polygraphy and
Muto1
features in PPG are linked to autonomic activity and increased EEG 1
GIGA – In Vivo Imaging | Liège University, Cyclotron Research Centre,
power density and cortical activity during sleep [2]. Therefore, we
Liège, Belgium; 2Centre for Chronobiology, Psychiatric Hospital of the
aimed to utilize deep learning to automatically identify sleep stages
University of Basel (UPK), Transfaculty Research Platform Molecular
from PPG.
and Cognitive Neurosciences (MCN), University of Basel, Basel,
Methods: PPG recordings from diagnostic polysomnographies of
Switzerland; 3Department of Electrical Engineering and Computer
805 patients with clinical suspicion of OSA were utilized to train and
Science, University of Liège; 4Department of Neurology, University
validate a combined convolutional and recurrent neural network.
Hospital of Liège; 5GIGA-­In Silico Medicine, University of Liège, Liège,
The deep learning model was trained for 3-­stage (wake/NREM/
Belgium
REM), 4-­stage (wake/N1 + N2/N3/REM), and 5-­stage (wake/N1/
N2/N3/REM) classification and the performance was tested with an
independent test set of 89 patients. Objectives/Introduction: Arousals during sleep are transient accel-
Results: In the independent test set, the 3-­stage model achieved an erations of the EEG signal typically detected by visual inspection of
epoch-­by-­epoch accuracy of 80.1% with Cohen's kappa (κ) of 0.65 to the sleep recording. Such visual identification is a time-­consuming,
the PSG-­based manual scoring. The 4-­stage model achieved 68.5% subjective process that prevents comparability across scorers, stud-
(κ=0.54) accuracy and the 5-­stage model achieved 64.1% (κ=0.51) ies and research centres. We developed an algorithm, which auto-
accuracy. The total sleep time was underestimated with a mean matically detects arousals in whole-­night EEG recordings, based on
(standard deviation) error of 7.5 (55.2) min with the 5-­stage classi- time and frequency analysis with adapted thresholds derived from
fication model. individual data.
Conclusions: The PPG-­based deep learning model accurately esti- Methods: We performed automatic arousals detection over 35 sleep
mated total sleep time and was capable of differentiating between recordings of young (μ=24.07 ± 3, N = 18) and older (μ=61.38 ± 6,
individual sleep stages with a moderate epoch-­to-­epoch agreement N = 17) healthy individuals, and compared it against human raters
to manual PSG-­based scoring. Applying the developed PPG-­based (HR) detection from two research centres. We assessed perfor-
sleep staging could improve the diagnostic yield of ambulatory mance of the automatic algorithm using generalized linear mixed
polygraphic recordings by enabling low-­cost, simple, and reliable models with Cohen's kappa as dependent variable. Performance of
automatic detection was compared to a gold standard, composed of
 |
98 of 356       ABSTRACTS
either all arousals found by any of the HR (inclusive detection – ID)
or only those common to both HR (conservative detection – CD).
Results: Comparison between human scorers revealed a high variabil-
ity in the number of arousals detected (μ=71 ± 32 vs 111 ± 50). Although
many more arousals were automatically detected (μ=200 ± 43), agree-
ment of automatic detection against human detection was high, as
reflected by very large Cohen's kappa values (κ=.93 for ID, .94 for
CD). Importantly, automatic detection was correlated to human de-
tection (r = .38, p = 0.025 for CD). Algorithm performance was not
significantly influenced by sleep stage (p = 0.74 for ID; p = 0.97 for CD),
age (p = 0.12 for ID; p = 0.91 for CD) or sex (p = 0.10 for ID; p = 0.21
for CD). We further found that relative power in the theta and alpha
bands were, respectively, higher and lower (p < 0.0001) for arousals
that were only detected by the algorithm, arguably making them less
obvious for the human eye.
Conclusions: Our results show that the automated algorithm is per-
forming at least equally as well as HR. While the automatic method
detects most of HR events, it finds many more events that bear the
characteristics of AASM arousals, but are missed by visual inspec-
tion of the EEG. This is seen for other micro-­events detectors such
as spindle detectors. In conclusion, our algorithm a reliable tool for
automatic detection of arousals.
Disclosure: Nothing to disclose.
P58 | Individual nocturnal cardiac autonomic
activity and sleep patterns in elite female soccer
players during an international tournament
J. Costa1,2; P. Figueiredo2,3; F. Nakamura4; V. Rago2,5; A.
Rebelo1; J. Brito2
1
Centre of Research, Education, Innovation and Intervention in Sport,
Faculty of Sports, University of Porto, Porto; 2Portugal Football School,
Portuguese Football Federation, FPF, Oeiras; 3Research Center in
Sports Sciences, Health Sciences and Human Development, CIDESD,
University Institute of Maia, Maia, Portugal; 4Associate Graduate
Program in Physical Education UPE/UFPB, PB, Brazil., João Pessoa,
Brazil; 5Faculty of Health Sciences and Sports, Universidade Europeia,
Lisbon, Portugal
Objectives/Introduction: Individual sleep and heart rate variability
(HRV) responses may underpin how athletes tolerate training and
match load. Moreover, fatigued athletes may get overlooked when
evaluating team-­averaged data reports. Therefore, the aim of this
study was to describe individual sleeping patterns and nocturnal
cardiac autonomic activity of National team female soccer players
during an international tournament.
Methods: Twenty elite female soccer players (aged 25.2 ± 3.1 years)
wore wrist actigraph units and heart rate monitors during night-­
sleep throughout 9 consecutive days (6 day-­time training sessions,
2 day-­time matches and 1 evening-­time match) of an international
tournament. Training and match load was monitored using the
session-­rating of perceived exertion (s-­RPE) and wearable 10-­Hz
global positioning system (total distance covered and high-­speed
running).
Results: Individually, s-­RPE, total distance, exposure time, and high-­
speed running during training sessions ranged from 20 to 680 ar-
bitrary units (AU), 892 to 5176 m, 20 to 76 min, and 80 to 1140 m,
respectively. During matches, ranged from 149 to 876 AU, 2236 to
11210 m, 20 to 98 min, and 629 to 3213 m, respectively. As a group a
lower duration of total sleep time (TST) was observed after evening-­
time match (6:47 ± 0:58 hours) compared to all days of the tourna-
ment (p < 0.001). Individually, players slept less than recommended
(n = 11 players [55%]; < 7 hours) on several days of the tournament,
especially after evening-­time match (n = 8 players [40%]; TST rang-
ing between 6:00–6:54 h). During the tournament, the TST coef-
ficient of variation (CV) ranged between 3.1 and 18.7%. However,
all players presented good sleep quality (i.e., sleep efficiency ≥ 75%;
individual range between: 75–98%) for each day of the tournament.
Most of the players presented small fluctuations in nocturnal cardiac
autonomic activity (individual nocturnal HRV ranged between 3.91–
5.37 ms and HRV CV ranged between 2.8–9.0%), while two players
presented higher HRV CV (11.5 and 11.7%; respectively).
Conclusions: Overall, this study highlights the substantial individual
variability in sleep and HRV measures, suggesting the adoption of
an individual approach to analyse sleep, training and match load,
to better understand how players cope with highly demanding
competitions.
Disclosure: Nothing to disclose.
P59 | Variability of visual and automated sleep
stage scoring in elderly
D. Chylinski1; C. Berthomier2; E. Lambot1; S. Frenette3,4; C.
Schmidt1,5; M. Brandewinder2; J. Carrier4,6; G. Vandewalle1;
V. Muto1
1
GIGA – In Vivo Imaging | Liège University, Cyclotron Research Centre,
Liège, Belgium; 2PHYSIP, Paris, France, Paris, France; 3CIUSSS-­du-­
Nord-­de-­l’île-­de-­Montréal, Montréal; 4Department of Psychology,
University of Montreal, Montreal, QC, Canada; 5Psychology and
Cognitive Neuroscience Research Unit, University of Liège, Liège,
Belgium; 6CIUSSS-­du-­Nord-­de-­l’île-­de-­Montréal, Montréal, QC,
Canada
Objectives/Introduction: Visual scoring of sleep recordings is char-
acterized by inter-­scorer variability. This methodological issue can
be amplified in older individual recordings because sleep changes
markedly in aging. Here, we aimed to investigate sleep scoring vari-
ability in aged participants through a visual-­automatic sleep scoring
comparison.
Methods: Sleep recordings of 20 subjects (10 women, 61 ± 5 years)
were included. Automatic sleep scoring (AS) was performed by
Aseega algorithm, previously validated on young healthy participants.
ABSTRACTS
Visual scoring (VS) was performed by two experts (VS1, VS2) from
different centers according to AASM rules. Epoch-­by-­epoch agree-
ments (concordance and Conger's kappa coefficient, k) were com-
puted. Generalized linear mixed models assessed potential scorer
effects on sleep parameters (time spent in N1/N2/N3/REM, tN1/
tN2/tN3/tREM; wake after sleep onset, WASO; total sleep time,
TST; sleep efficiency, SE).
Results: Overall agreement between the 3 scorings was k = 0.60
(moderate). Pairwise agreements were as follows: VS1 vs. VS2, 76%
(k = 0.67); AS vs. VS1, 67% (0.54), AS vs. VS2, 74% (0.60). Agreement
between AS and consensual VS was 78% (0.60). GLMMs showed
disparate pairs of agreeing scorers depending on the sleep param-
eter considered. For tN1, AS showed differences with both VS
(p < 0.0001) who did not differ between themselves. Differences
were found between both VS for tN2 and tN3 (p < 0.0001) and
WASO (p = 0.006), while AS showed no significant difference with
VS2. All three scorers differed for TST (p = 0.05) and SE (p = 0.04).
No differences across scorers were found for tREM.
Conclusions: Agreement between scorers, whether between VS
or AS and VS proved lower than what is usually reported in the lit-
erature for the general population. This is likely due to the fact that
with ageing, sleep undergoes a series of changes with, at the mac-
rostructural level, lower sleep stability and, at the microstructural
level, lower EEG voltage dynamics. This certainly renders sleep more
difficult to score, which might lead to increased inter-­rater variability
and rises methodological questions relative to sleep scoring in the
aged population.
Disclosure: C. Berthomier and M. Brandewinder have ownership/
directorship and are employees of Physip.
P60 | Are there sleep related differences in
the neurotransmitters Glutamate and GABA
between typical developing children and children
with ADHD?
C. Volk1; V. Jaramillo2; M. Furrer2; M. Studler3; R. O'Gorman
Tuura1; R. Huber2,4
1 2
Center for MR-­Research; Child Development Center, University
Children's Hospital Zurich, Zurich; 3Department of Social Neuroscience
and Social Psychology, Institute of Psychology, University of Bern, Bern;
4
Department of Child and Adolescent Psychiatry and Psychotherapy,
Psychiatric Hospital University of Zurich, Zurich, Switzerland
Objectives/Introduction The balance between the neurotransmit-
ters Glutamate and GABA is important for healthy brain develop-
ment. The concentrations change across the lifespan. Children with
ADHD depict altered levels in both GABA and Glutamate compared
to their healthy peers. Sleep has been shown to be significantly in-
volved in the regulation of these neurotransmitters. The goal of this
project is to investigate the sleep-­related processes that underpin
the (im)balances between Glutamate and GABA in healthy children
|
      99 of 356
and children with ADHD. More specifically, we investigated if over-
night changes in these metabolites are 1) associated with electro-
physiological markers of sleep quality (slow wave activity, SWA) and
2) linked to the sleep-­related brain clearance system by means of
changes in CSF flow within the cerebral aqueduct.
Methods: Subjects comprise 15 children/adolescents with ADHD
and 26 healthy controls (age 8–17 years). MRI sequences included
magnetic resonance spectroscopy (MRS), T1-­weighted scans and a
phase contrast sequence. All scans were performed in the evening
after a day of wakefulness and in the morning after a night of sleep.
The night in-­between was recorded with EEG.
Results: Our preliminary analysis focused on GLX. Children with
ADHD depict higher levels of GLX in the evening (t = −3.4, p = 0.01)
compared to healthy controls. No differences between the groups
were present in the morning (p = 0.6). The direction of GLX changes
differed between the groups (z  =  −2.7, p  =  0.03, ADHD  =  −6.6%,
healthy controls= +2.8%). Changes in GLX were not associated with
SWA in healthy children (p = 0.3) and children with ADHD (p = 0.9).
Conclusions: These results suggest that children with ADHD pre-
sent different dynamics of GLX across sleep and wake. The complete
data set (including CSF flow) might elucidate if these differences are
fostered by an alteration in the sleep related clearance system of
the brain.
Disclosure: Nothing to disclose.
P61 | Sleep and insomnia-­related complaints
before and during imposed confinement in the
COVID-­19 pandemic: results from a global survey
C. Colomb1; J. Newell1; A. Putilov2; B. Delwiche3; O.
Benkirane 4; M. Windal4; J. Carrasquer-Ferrer5; G. Briganti5;
B. Riahi5; C. Kornreich4,5; O. Vermylen5; J. Cedernaes6; P.-H.
Luppi7; P. Peigneux4; N. Pattyn3; D. Neu1,8; O. Mairesse1,9
1
Sleep Laboratory and Unit for Clinical Chronobiology, Brugmann
University Hospital, Brussels, Belgium; 2Research Institute for
Molecular Biology and Biophysics of the Federal Research Centre
for Fundamental and Translational Medicine, Novosibirsk, Russian
Federation; 3Vrije Universiteit Brussel; 4Université Libre de Bruxelles;
5
Brugmann University Hospital, Brussels, Belgium; 6Uppsala University,
Uppsala, Sweden; 7Centre de Recherche en Neurosciences de Lyon,
Lyon, France; 8Laboratoire du Sommeil, Centre Hospitalier Interrégional
Edith Cavell; 9Brain, Body and Cognition, Vrije Universiteit Brussel,
Brussels, Belgium
Objectives/Introduction: Lockdown strategies due to the COVID-­19
pandemic could potentially increase the risk of developing or sus-
taining insomnia-­related sleep complaints. However, these strategies
might also have salutogenic effects on individuals with insufficient
sleep.
 |
100 of 356       ABSTRACTS
Methods: 7140 individuals (M age = 42.18, SD = 15.04) partici-
pated in an online survey in 9 languages distributed over different
European countries during the lockdown period (April-­May 2020).
Results: During lockdown, 19.2% of participants reported moder-
ate to severe insomnia-­related symptoms, compared to 7% before
the pandemic. 36.2% of participants indicated a worsening of symp-
toms, while 8.6% improved. Compared to individuals having similar
insomnia-­related complaints before and during lockdown, improving
in symptoms was significantly related with younger age, being a fe-
male and not practicing a job requiring presential activity. However,
worsening of symptoms was significantly associated with more
COVID-­related stress and anxiety, and depressive symptoms. Being
younger and having to perform a professional activity, whether it
is home-­
based or not, also increased the odds of having worse
insomnia-­related symptoms. In general, being confined was associ-
ated with later bedtimes, later rise times, longer sleep latency and a
decrease of total sleep time. However, both individuals with worsen-
ing and improving insomnia-­related symptoms increased their bed-
time even more than individuals with similar sleep complaints before
and during lockdown. Also, individuals with less insomnia-­related
complaints during lockdown rose about half an hour later than those
with similar or worsening insomnia complaints. Individuals with
worsening insomnia complaints took roughly 25 minutes more to fall
asleep compared to before lockdown, while subjective sleep laten-
cies remain similar in other individuals. Regarding total sleep time,
individuals reporting an improvement of insomnia-­
related com-
plaints slept approximately 45 minutes more, while those reporting
a worsening of complaints slept around 45 min less (al p's < 0.001).
Conclusions: While pandemic-­induced lockdown strategies induce
or maintain insomnia symptoms, a majority of participants re-
ported only limited effects on sleep complaints compared to before
the confinement period, some even reporting an improvement in
symptomatology.
Disclosure: Nothing to disclose.
P62 | Comorbidities in patients with coexisting
obstructive sleep apnea and heart failure with
different ejection fractions
C.L. Ardelean1; S. Pescariu2; D.F. Lighezan2; R. Pleava3; S.M.
Frent4; A. Lechocz5; S. Mihaicuta4
1 P63 | A network meta-­analysis of the efficacy
Pneumology, Cardioprevent Foundation; 2Cardiology; 3University
of Medicine and Pharmacy Timisoara; 4Pneumology, University of
Medicine and Pharmacy Timisoara; 5Pneumology, Victor Babes
Hospital of Infectious Diseases and Pneumology, Timisoara, Romania
Objectives/Introduction: Assessment of particularities of patients
with coexisting obstructive sleep apnea (OSA) and heart failure (HF)
Methods: 143 OSA and HF patients were evaluated in a sleep labs
in Timisoara. We collected socio-­demographic data, neck/abdomi-
nal circumference (NC, AC), sleep questionnaires, comorbidities,
blood test data, polygraphy and echocardiographic measurements.
Patients were divided depending on ejection fraction (EF): pre-
served EF  ≥  50%(HFpEF), reduced EF  <  50%(HFrEF). Each group
was divided depending on apnea-­
hypopnea index (AHI): < 30%
(mild-­moderate OSA), ≥30% (severe OSA). All data analyses were
performed with Stata 15.1 (Statacorp, Texas USA) and p value < 0.05
was considered significant.
Results: HFrEF: 50 (35%) patients, 18 (36%) mild-­moderate OSA
vs 32 (64%) severe OSA, male 14 (77.7%) vs 23 (71.8%), age 65
(59–68) vs 63 (59–73), BMI 31.5 (29–36) vs 36 (33–42) (p = 0.018),
NC 41.4 ± 5 vs 44.7 ± 3.9 (p = 0.012), AC 117.5 (110–125) vs 125
(115.5–130).
HFpEF: 93 (65%) patients, 27 (29%) mild-­moderate OSA vs 66 (71%)
severe OSA, male 18 (66.7%) vs 44 (66.7%), age 58 (51–64) vs 61
(58–67) (p = 0.053), BMI 34 (29–37) vs 39 (33–42) (p = 0.025), NC
40.9 ± 4.3 vs 44.4 ± 4.5 (p < 0.05), AC 115 (105–123) vs 123 (117–
132) (p < 0.05).
Regardless of EF, severe OSA patients have significant difference
in sleep parameters AHI, central/ obstructive/ mixed Apnea Index,
Oxygen Desaturation (p < 0.05).
In HFrEF, mild-­moderate OSA patients have more diabetes melli-
tus (DM)(83.33% vs 56.25%), myocardial infarction (MI)(44.44% vs
18.75%), chronic obstructive pulmonary disease (COPD)(66.67% vs
15.63%).
In HFpEF, mild-­moderate OSA patients have more aortic regurgita-
tion (AR)(33.33% vs 15.15%) and severe OSA patients have increased
hypertension duration (HTd)(10 vs 7 years), (p < 0.05).
In mild-­moderate OSA, HFrEF patients have increased HTd (10 vs
7 years), DM (83.33% vs 33.33%), MI (44.44% vs 7.41%), tricuspidian
regurgitation (88.89% vs 55.56%), COPD (66.67% vs 18.52%) and in
severe OSA, HFrEF patients have more atrial fibrillation (59.38% vs
34.85%), MI (18.75% vs 4.55%), AR (43.75% vs 15.15%) and chronic
kidney disease (43.75% vs 19.70%), (p < 0.05).
Significant correlation was observed between AHI and AF
(OR = 0.029, 95% CI) and between AHI and AR (OR = 0.052, 95% CI)
in the entire group.
Conclusions: Patients with coexisting HFrEF and OSA, regardless of
AHI are more likely to have multiple comorbidities with increased
mortality.
Disclosure: Nothing to disclose.
of hypnotics for insomnia in older adults
H.-Y. Chiu1; P.-Y. Chen2
1
Taipei Medical University; 2Chang Gung Memorial Hospital, Taipei,
Taiwan
Objectives/Introduction: Hypnotics have been used to aid sleep and
treat insomnia in older adults. However, knowledge regarding rela-
tive efficacy and safety of various hypnotics remains unknown. The
ABSTRACTS
purpose of the study was to assess the comparative efficacy and
safety of different hypnotics for insomnia in older adults.
Methods: We searched EMBASE, PubMed, ClinicalTrials.gov, and
ProQuest Dissertations and Theses A&I databases from inception
to July 13, 2019. Only randomized controlled trials (RCTs) compar-
ing hypnotics with either another hypnotic or placebo for insomnia
treatment in elderly people. The primary outcomes were objec-
tive total sleep time (oTST), sleep onset latency (oSOL), number of
awakening (oNAW), and sleep efficiency (oSE) measured by poly-
somnography and subjective sleep parameters (i.e., sTST, sSOL, and
sNAW) assessed using self-­reported tools. Secondary outcome was
treatment-­
related adverse events. A multivariate random effect
meta-­regression model was used for estimations of treatment ef-
ficacy and safety.
Results: Twenty-­two RCTs with 5172 older adults were included.
Eszopiclone was ranked as the best therapy for prolonging oTST
(28.60 mins, 95% confidence interval [CI] = 18.14 to 39.06), and
doxepin appeared to be the optimal treatment for increasing sTST
(28.19 mins, 95% CI = 11.85 to 44.52) and enhancing oSE (6.8%,
95% CI = 4.10 to 8.07) compared with placebo/control. Zaleplon
was the most effective therapy in reducing oSOL (−21.63 mins, 95%
CI = −32.33 to −10.93) and sSOL (−15.92 mins, 95% CI = −26.60 to
−5.06) compared with placebo/control. The risk of overall adverse
events was highest with triazolam use (odd ratio, 1.89, 95% CI, 1.10
to 3.25) compared to placebo.
Conclusions: Considering the potential adverse effects of BZDs and
non-­BZDs, low-­dose doxepin may be the optimal pharmacotherapy
for improving sleep duration and SE. Future RCTs investigating the
treatment effects of hypnotics, particularly low-­dose doxepin, on in-
somnia in older adults are warranted.
Disclosure: Nothing to disclose.
P64 | Impact of napping and sleep-­education
on daytime functioning in older adults
A. Lesoinne1; M. Reyt1,2; D. Michele1; M. Baillet1; S. Laloux1;
E. Lambot1; G. Hammad1; V. Muto1; C. Schmidt1,2
1
GIGA – CRC In Vivo Imaging; 2Psychology and Neurosciences of
Cognition (PsyNCog), Université de Liège, Liège, Belgium
Objectives/Introduction: Even though common among the elderly
and potentially affecting sleep-­wake regulation, napping is barely
considered as a modulatory factor in daytime functioning models.
We aimed at exploring whether chronic napping influences daytime
drowsiness, affect, and depressive feelings in healthy older adults.
Methods: Drowsiness (Epworth Sleepiness Scale, ESS), affects
(Positive-­Negative Affects Scale (PANAS) and depressive feelings
(Beck Depression Inventory (BDI-­
II)) were assessed in thirty-­
six
older participants (59–81  years; 21 men; 25 chronic nappers; ≥3
naps of at least 45 min per week). After baseline assessment, all
participants underwent a sleep-­education with half of the nappers
|
      101 of 356
receiving targeted recommendations on nap suppression (behav-
ioural intervention following guidelines of cognitive-­
behavioural
therapy, NAP_INT, n = 10), while the other half (NAP_CTRL, n = 15)
and a group of no-­nappers (NONAP_CTRL, n = 11) received sleep-­
education without targeted recommendations on napping behav-
iour. After this session, participants were monitored by actimetry
and monthly followed-­up to assess treatment adherence, drowsi-
ness, affects and depressive feelings (6-­months follow-­up for ESS,
5-­months follow-­up for PANAS and BDI-­II). Statistical analyses in-
cluded the factor ‘time’ and ‘group’ and non-­parametric tests were
applied when recommended.
Results: At baseline, nappers felt drowsier and had higher values
on a depression index compared to no-­nappers (ESS: Z  =  −2.112,
p = 0.035, BDI-­II: Z = −2.576, p = 0.010) while no significant group
differences were observed at follow-­up (ESS: Z = −1.494, p = 0.135,
BDI-­II: Z = −0.893, p = 0.372). For negative affect, we observed a sig-
nificant time*group interaction (PANAS-­negative affect; Z = 2.412,
p = 0.034). Post-­hoc contrasts indicated that the NAP_INT group
tended to decrease in their ratings from baseline to follow-­
up
(p = 0.069), while the ratings of the two other groups didn't change
over time.
Conclusions: Overall, nappers felt drowsier and more depressive
compared to non-­nappers at baseline. Furthermore, the nap suppres-
sion intervention tended to reduce negative affect and thus might
be beneficial for daytime functioning in older adults. However sea-
sonality could have a strong influence on affective and drowsiness
measures. Therefore, future analyses will include more individuals,
assessed at different seasons over follow-­up, as data acquisition is
still ongoing.
Disclosure: The authors have no conflict of interest to disclose.
Sources of funding: Belgian Fund for Scientific Research (FNRS),
European Research Council (ERC-­Starting Grant).
P65 | Identifying anatomical factors of
obstructive sleep apnea by ultrasound fan-­scan
imaging of pharyngeal airway
A. Chen1; P.-L. Lee2; C.-C. Shu2; Y.-W. Kuo2; C.-N. Chen1;
H.-C. Wang2
1
National Taiwan University; 2National Taiwan University Hospital,
Taipei, Taiwan
Objectives/Introduction: It has been reported that changes in di-
ameter of the pharyngeal airway observed by submental ultrasound
scan are associated with obstructive sleep apnea (OSA). However,
the airways are sometimes not observable in ultrasound imag-
ing possibly due to soft tissue displacement caused by gravitation
or Müller′s Maneuver. This research aims to study how the airway
observabilities and observable diameter changes are related to the
OSA severity.
 |
102 of 356       ABSTRACTS
Methods: 112 patients (74.1% male, median AHI of 24, median age
of 51, and median BMI of 27.25) from the Sleep Center of National
Taiwan University Hospital were recruited in the study. To stand-
ardize the ultrasound scan, a cross-­section plane passing through
the Hyoid bone and the external acoustic Meatus (HM plane) was
defined and delineated by laser projection. The ultrasound probe
was positioned to align with the laser-­projected HM plane followed
by a 20-­degree fan scan on the awake supine patient to acquire a
sequence of images covering a sector area of the pharynx. The im-
ages were divided into three parts: the highest sector area (retro-
palatal area), the center sector area (oropharyngeal area), and the
lowest sector area (retroglossal area). Three replicate fan-­scans were
performed for both tidal breathing and Müller′s Maneuver (MM) by
each patient. The airway observabilities and the observable widths
were evaluated using an FDA-­cleared software (AmCAD-­UO). Non-­
parametric tests were then used to identify significant factors on
the AHI and ODI.
Results: For both AHI and ODI, airway width changes in all three
areas: retropalatal (p-­value = 0.0168, 0.0214), oropharyngeal (p-­
value = 0.0011, 0.0023) and retroglossal (p-­value = 0.0325, 0.0479),
were found significant while the observabilities of the oropharyn-
geal airway during tidal breathing (p-­value = 0.0144, 0.017), and
the retroglossal airway under MM (p-­value = 0.0075, 0.0248) were
also found critical. Additionally, the observability of the retropala-
tal airway under MM (p-­value = 0.0357) was also found significant
for ODI. Using the significant anatomical factors and the BMI, a re-
gression model was built to predict the moderate-­severe OSA with
AUROC = 0.832.
Conclusions: With ultrasound imaging of the pharyngeal airway, the
airway observabilities and diameter changes could be systemati-
cally recorded and quantified. The critical anatomical factors found
by this study were shown valuable for differentiating patients with
moderate-­severe OSA.
Disclosure: This research was partially funded by AmCAD BioMed.
P66 | Obstructive sleep apnea and evolution of
Alzheimer′s disease patients
1 2 1 2
G. Piñol-Ripoll ; A. Targa ; F. Dakterzada ; I. Benitez ; A.
Carnes1; F. Barbe2
1 and repercussion on functional status is scarce.
Unitat Trastorns Cognitius, Clinical Neuroscience Research, Santa
2 To identify the prevalence of atrial arrhythmias during sleep in
Maria University Hospital, IRBLleida; Translational Research in
Respiratory Medicine, Hospital Universitari Arnau de Vilanova-­Santa
Maria, IRBLleida, Lleida, Spain
Objectives/Introduction: To investigate the effect of OSA on the
cognitive evolution of patients with AD.
Methods: In this prospective, single-­center study (NCT02814045),
patients with mild-­moderate AD with and without untreated OSA
were evaluated at the baseline and after 12, 24 and 36 months of fol-
low-­up. OSA was defined as an apnea-­hypopnea index (AHI) > 15/h.
The primary outcome was measured by the cognitive scores on the
Alzheimer's Disease Assessment Scale-­Cognitive subscale (ADAS-­
cog) and Mini-­Mental State Examination (MMSE).
Results: The cohort included 146 patients with 125 validated PSGs,
from which 40 patients were diagnosed as non-­OSA (32%) and 85
as OSA (68%). The median [IQR] age of the eligible individuals was
75.0 [72.0;80.0] years and the majority was composed of women
(57.25%). In addition, the mean (SD) MMSE score at the baseline was
23.53 (2.23).
In the ADAS-­cog score, the mean (SD) change at the 12 months of
follow-­up was 2.97 (5.73) and 0.29 (5.65) for the non-­OSA and OSA
group, respectively. The estimated mean (95%) difference between
the groups was −2.76 (0.12 to 0.16) (p = 0.033). No cognitive changes
were observed at several cognitive domains evaluated. There was
a cognitive decline along the 3 years of follow-­up according to the
MMSE score (p < 0.001) (Figure 1), but no differences between the
groups were observed.
Conclusions: OSA was not associated with a worse cognitive evolu-
tion after 36 months of follow-­up. Further studies will be necessary
to improve the understanding of the OSA impact on the cognitive
evolution of AD patients.
Disclosure: Nothing to disclose.
P67 | Prevalence of nocturnal tachyarrhythmias
and long-­term functional outcome in patients
with obstructive sleep apnea syndrome and
acute ischemic stroke
D.G. Martínez Roque; J.M. Martínez Valenciano; A. Gonzalez
Aquines; R. Galicia Carriles; N. Vázquez Resendez; B.E.
Chávez Luévanos; F. Guerrero Campos; F. Gongora Rivera
Neurology, Hospital Universitario ‘Dr. José Eleuterio González’
Universidad Autónoma de Nuevo León, Monterrey, Mexico
Objectives/Introduction: Obstructive sleep apnea syndrome (OSAS)
is characterized by repetitive collapse of the airway during sleep and
is considered a risk factor for ischemic stroke. Heart rhythm altera-
tions have been reported in up to 50% of patients with OSAS, how-
ever, information about their prevalence in acute ischemic stroke
patients with OSAS and ischemic stroke and its repercussion at
3 months after discharge.
Methods: Cohort study of patients with acute stroke admitted to
the Neurology Service of the University Hospital ‘José Eleuterio
González’ of the UANL during December-­2016 to April-­2019. A 24-­
hour cardiac monitoring and polygraphy were performed during
hospitalization. SAOS was defined as apnea/hypoapnea index > 15.
Subsequently, an evaluation at 3 months after the patient's hospital
discharge was carried out to evaluate their functional independence
ABSTRACTS
Results: 137 patients were included, average age 60.25 (± 14.13)
years. We classified 65 (47.1%) subjects with SAOS. Subjects with
OSAS had a higher prevalence of atrial tachyarrhythmias during
sleep (p ≤ 0.001) and a worse NIHSS (p = 0.026) and Rankin at dis-
charge (p = 0.002). The functional status at 3 months was less fa-
vorable in the group with OSAS and tachyarrhythmias (p = 0.002).
Conclusions: There is a relationship between tachyarrhythmias dur-
ing sleep and OSAS. Its presence could influence the prognosis and
functional recovery of patients with acute stroke, so the diagnosis
and treatment of sleep disorders should be part of the approach of
patients with acute ischemic stroke.
Disclosure: Nothing to disclose.
P68 | Changes in an electroencephalographic
marker of synaptic renormalization during sleep
after ischemic stroke
V. Jaramillo1,2; J. Jendoubi3,4; A. Maric5; C. Bassetti3,4; R.
Huber1,6,7
1
Children's Research Center, University Children's Hospital Zurich;
2
Child Development Center, University Children's Hospital Zurich,
3 4
Zurich; Sleep-­Wake-­Epilepsy Center; Center for Experimental
5
Neurology, University Hospital Bern, Bern; Department of Neurology,
University Hospital Zurich, University of Zurich; 6Child Development
Center, University Children's Hospital Zurich; 7Department of Child and
Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital of the
University of Zurich, Zurich, Switzerland
Objectives/Introduction: The restorative function of sleep has been
linked to an overall reduction in synaptic strength. Slow waves, a
major characteristic of non-­rapid eye movement sleep, are thought
to mediate this so-­called synaptic renormalization which is directly
reflected in overnight slow wave slope changes. Both the thalamus
and the cortex are involved in slow wave generation but it is currently
unknown how much the thalamus contributes to synaptic renor-
malization. We aim to address this question by comparing overnight
slope changes between thalamic and non-­thalamic ischemic stroke
patients in a longitudinal setting.
Methods: All-­
night high-­
density electroencephalography was
recorded in 37 patients (22–82 years, 10 females) in the acute
(1–8 days) and subacute (1–6 months) phase after an ischemic stroke.
17 nights (N = 11 acute, N = 6 subacute) of thalamic stroke patients
and 15 nights (N = 7 acute, N = 8 subacute) of non-­thalamic stroke
patients were included in the analysis. To control for amplitude
changes, slow waves from the first and the last hour NREM sleep
were matched according to their amplitude and then divided into 5
amplitude quintiles.
Results: Thalamic and non-­thalamic patients did not differ in terms of
age, sleep duration or apnea-­hypopnea index. A linear mixed-­effects
model was calculated to assess the effects of stroke and recording
session (acute/subacute) on overnight slope changes. Overnight
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slope changes were reduced across the scalp in thalamic compared
to non-­thalamic stroke patients (6.52%, p = 0.016) for large ampli-
tude waves (80–100%) but not for smaller amplitude waves (0–80%).
The recording session and the interaction between recording ses-
sion and stroke did not have a significant effect on overnight slope
changes.
Conclusions: The reduced overnight slope change for large ampli-
tude waves in thalamic stroke patients might reflect impaired synap-
tic renormalization during sleep. This impairment does not seem to
recover from the acute to the subacute session. These results sug-
gest that the thalamus may be important for synaptic renormaliza-
tion and restoration during sleep and that damage to the thalamus
may have long-­lasting effects.
Disclosure: Nothing to disclose.
P69 | Slow-­wave sleep and cognitive
impairment in Parkinson disease
S.J. Schreiner; L.L. Imbach; P.O. Valko; A. Maric; R. Maqkaj;
E. Werth; C.R. Baumann; H. Baumann-Vogel
Department of Neurology and Clinical Neuroscience Center, University
Hospital Zurich, University of Zurich, Zurich, Switzerland
Objectives/Introduction: Cognitive impairment is a common
and disabling feature of Parkinson disease (PD), with a high risk
of dementia. Slow-­wave sleep (SWS) has emerged as a potential
mechanistic pathway and therapeutic target in neurodegenerative
diseases. Reduced SWS associates with cognitive impairment and
pathology in Alzheimer disease. In PD, sleep disturbances are linked
with cognitive impairment, but the importance of SWS for cognition
in PD is unknown.
Methods: Non-­demented PD patients (n = 140; females = 44%;
age = 62.6 ± 9.1 years, mean±SD) underwent video-­polysomnography
and screening for cognitive impairment with the Montréal Cognitive
Assessment (MoCA). We performed sleep stage scoring and quanti-
fied spectral power densities, including averaged whole-­night slow-­
wave activity (SWA), which we compared to MoCA performance.
Results: Cognitive screening identified 35 patients (25%) as cogni-
tively impaired (MoCA = 23.1 ± 1.6, mean±SD) and 105 as cogni-
tively normal (MoCA = 28.2 ± 1.4, mean±SD). Cognitively impaired
patients showed reduced 1–4 Hz SWA (p = 0.03) and 1–2 Hz SWA
(p = 0.003) compared with cognitively normal patients. Reduced
1–2 Hz SWA was associated with worse MoCA performance in all
140 patients (p = 0.01). This association remained significant after
controlling for relevant covariates and was not observable for spec-
tral power in higher frequency ranges.
Conclusions: We provide preliminary evidence that cognitive impair-
ment in PD is associated with reduced SWA, particularly in the lower
delta frequencies. Our finding suggests a potential role of reduced
SWS intensity in PD cognitive impairment.
Disclosure: Nothing to disclose.
 |
104 of 356       ABSTRACTS
P70 | Modified melatonin profile, shorter
sleeping time and poorer sleep quality in children
with obesity
M. Gombert1; V. Martin-Carbonell1; A. Carrasco-Garcia1; G.
Pin-Arboledas2; J. Carrasco-Luna1,3; P. Codoñer-Franch4,5
1
Department of Pediatrics, Obstetrics and Gynecology, University
2
of Valencia; Department of Pediatrics, Pediatric Sleep Unit,
Quironsalud Hospital; 3Biotechnology, Catholic University of Valencia;
4
Department of Pediatrics, Obstetrics y Gynecology, University of
Valencia; 5Service of Pediatrics, Universitary Hospital Dr. Peset of
Valencia, Valencia, Spain
Objectives/Introduction: Sleep and circadian rhythms are main reg-
ulators of metabolism. Several studies have evidenced their impor-
tance in the development of pathologies such as obesity in human
adults but only few studies have investigated these mechanisms in
childhood. Consequently, we have undertaken a study of the qual-
ity of sleep, life habits, and metabolic parameters quantifying and
relating melatonin levels over evening in a group of children with and
without obesity.
Methods: In 170 children (87 girls) from 7 to 14 years melatonin was
quantified by ELISA with Salimetrics kit in saliva at three time-­points
over evening: four hours before bedtime, two hours before bedtime,
and one hour after sleep. Obesity according to WHO classification
was present in 125 children. Metabolic and inflammatory param-
eters were also determined by Luminex immunoassay, and we used
questionnaires to collect data on sleep (Chervin et al. 2000) and on
life habits. Statistical analysis was performed by using SSPPS 21.
Results: Two hours before bedtime, children with obesity displayed
a different melatonin expression, with higher level (15,4 pg/ml) com-
pared to controls (9,8 pg/ml, p = 0.03). They also reported a shorter
sleeping time during the week than the controls (8 h41 vs 9 h16,
p = 0.009), although sleep duration during the weekend was not sig-
nificantly different between groups. The children with obesity pre-
sented higher score for Chervin's test for sleep disorders (p = 0.05),
and also have more electronic devices in their room than the controls
(p = 0.02). Regarding metabolic characteristics, increased insulin re-
sistance in obesity group was shown by both HOMA and QUICKI
indexes (p < 0.001), triglycerides are higher (p < 0.001), and adi-
ponectin and leptin hormones were increased (p < 0.001).
Conclusions: The present study provides an association of childhood
obesity with modified melatonin profile, shorter sleep duration, and
poorer sleep quality. Obese children also have more electronic de-
vices in their bedrooms, increasing the temptation of using them
during the night. We are now investigating if individual personalized
recommendation of life habits modifications for sleep improvement
is a useful tool to add to the basic nutritionist intervention.
Disclosure: Nothing to disclose.
P71 | Effects of sleep loss and attention on
negotiations
T. Sundelin1,2,3; T. West3; J. Axelsson1,2
1
Department of Clinical Neuroscience, Karolinska Institutet; 2Department
of Psychology, Stockholm University, Stockholm, Sweden; 3Department of
Psychology, New York University, New York, NY, United States
Objectives/Introduction: Although there is a growing interest in the
effect of sleep loss on social behaviors, little is known about actual
social interactions following sleep deprivation. Many social exchanges
involve some kind of negotiation, ranging from discussing one′s salary
with a supervisor to deciding who will prepare dinner in a household.
As sleep-­deprived individuals have a shorter attention span, decreased
executive functions, and are more emotional, we hypothesized that
sleep loss would lead to worse negotiation abilities. We also predicted
that this would be mediated by decreased attention.
Methods: In the first study, 182 participants were randomised to
one night of total sleep loss or normal sleep. The following day, they
performed a 15-­minute dyadic collaborative task, where they ne-
gotiated for the best possible outcome for the dyad. In the second
study, 106 participants were randomised to two nights of 4 h sleep
per night or two nights of 8 h sleep per night, after which they per-
formed a 6-­minute dyadic negotiation task where the dyad partners
had opposing goals. Prior to the negotiation tasks, participants per-
formed a short psychomotor vigilance task.
Results: Although sleep loss affected reaction time on the PVT
(p < 0.001 and p = 0.02, respectively), and longer reaction times
predicted worse negotiation outcomes in the opposing-­
goals task
(p = 0.009), there was no effect of sleep loss on negotiation outcome
in either study (p = 0.37 and p = 0.66, respectively). Reaction times did
not predict negotiation outcomes in the collaborative task (p = 0.95).
Conclusions: Sleep loss does lead to decreased attention, which is
useful for negotiation ability, but despite this, there was consistently
no effect of insufficient sleep on negotiation outcomes in two large
studies. Potentially, negative effects of sleep loss would be more
prominent in longer negotiation settings, where lapses in attention
may be more frequent.
Disclosure: Nothing to disclose.
P72 | Personality and work related cognitions
associated with healthy sleep in employees with
regular working schedules
S. Carvalho Bos; B. Silva; M.J. Soares; A.T. Pereira; A. Macedo
Institute of Psychological Medicine, Faculty of Medicine, University
of Coimbra, Coimbra, Portugal
Objectives/Introduction: Healthy sleep is essential for human well-­
being. The main objective of this study was to investigate the role of
personality traits and work related cognitions in healthy sleep.
ABSTRACTS
Methods: A total of one hundred eleven employees with regular
working hours with a mean age of 44.3 years (24–65; ± 9.97) and
female (72.1%) took part of the study. Self-­reported questionnaires
about demographic characteristics, healthy sleep, personality traits
and work related cognitions were completed. Variables related to
calm and deep sleep, good sleep quality, satisfaction with sleep,
sleep throughout the night without awakenings, ease of falling
asleep and waking up were merged to create an healthy sleep index.
Correlational and regression analyses were performed. Statistical
significance was set at p < 0.05.
Results: Correlations analyses revealed that extraversion was posi-
tively associated with healthy sleep (r = .301, p < 0.01) while neu-
roticism and arousability traits were negatively associated (r = -­.547,
p < 0.01; r  =  −210, p < 0.05, respectively). Regression analyses re-
vealed that neuroticism was the personality trait that most ac-
counted for the proportion of healthy sleep variance [R 2=.190, F(1,
92) = 26.513, p < 0.001] followed by arousability [R 2 change = .088,
2
F(1, 93) = 9.635, p = 0.003] and extraversion [R change = .046, F(1,
91) = 6.853, p < 0.001]. Cognitions as not being able to stop think-
ing about work at night while trying to sleep, ruminate about past
events or current daytime events and worry about next day activi-
ties or with the future were negatively associated with healthy sleep
(r = -­.34; r = -­.37; r = -­.52; respectively, p  <  0.05); perception that
efforts at work were properly rewarded or that the person had au-
tonomy at work were positively associated (r = .28; r = .25; p < 0.05).
Regression analyses revealed that worrying less about next day
activities or with the future and perception of autonomy at work
were the variables that mostly accounted for healthy sleep vari-
ance [R 2=.229, F(1, 107) = 31.84, p < 0.001); R 2 change = .038, F(2,
106) = 5.57, p = 0.020)].
Conclusions: Employees with lower levels of arousal and neuroticism
traits and more extraverted were more likely to experience healthier
sleep as well as the ones who worried less about next day activities
or with the future or the ones who perceived themselves as having
more autonomy at work.
Disclosure: Nothing to disclose.
P73 | Prior knowledge: a prerequisite to sleep-­
dependent declarative memory consolidation
processes in children?
A. Peiffer1; L. Hamdar1; P. Peigneux1; X. De Tiège2; C.
Urbain1
1
Faculté des Sciences Psychologiques et de l’Éducation; 2Université
Libre de Bruxelles (ULB), Brussels, Belgium
Objectives/Introduction: In adults, recent behavioural studies sug-
gest that the influence of sleep on declarative memory consolida-
tion processes is enhanced by the existence of prior knowledge
related to newly memory traces. Yet this process remains virtually
unexplored in children. To fill this gap, we investigated how prior
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knowledge impacts sleep-­dependent memory consolidation perfor-
mance in children.
Methods: Twenty-­nine children (7–11 years old) were randomly as-
signed to a Sleep (15 children, 9.75 ± 0.56 yrs, 8 F) or a Wake (14
children, 8.86 ± 1.23 yrs, 12 F) Group. Participants learned 50 novel
associations between familiar objects and faces, including 25 known
faces (extracted from children's cartoon) and 25 unknown faces.
Participants were asked to retrieve the familiar object associated
with a face (Known or Unknown according to the condition) during
an immediate (IR) and a delayed retrieval (DR) sessions. In the Sleep
group, IR occurred in the evening and DR the next morning whereas
in the Wake group, IR occurred in the morning and DR in the evening
(11 hours later).
Results: In the Known condition, a T-­test for independent groups
(Sleep vs. Wake) showed significantly higher retention indexes (%
correct retrieval at DR minus IR) in the Sleep group compared with
the Wake group (Sleep: mean ± SD % −5.9 ± 8.3; Wake: −15.4 ± 7.7;
t(27) = 3.22; p = 0.003). Retention indexes (% correct retrieval at DR
minus IR) did not differ between groups in the Unknown condition
(Sleep: mean ± SD % −6.93 ± 10.2; Wake: −10.6 ± 16.7; t(27) = 0.71;
p = 0.48).
Conclusions: Our results show that, in children, a night of sleep may
support memory consolidation only for new memory traces related
to prior knowledge. Although a proper comparison between adults
and children remains necessary, this study suggests that, as in adults,
prior knowledge is a potential prerequisite to sleep-­
dependent
memory consolidation processes already in school-­age children.
Disclosure: Nothing to disclose.
P74 | What do we remember from sleep?
Influence of sleep stage and sleep inertia on
information encoding
T. Reess1; J. Axelsson1,2
1
Department of Clinical Neuroscience, K8, Psychology, Karolinska
Institutet; 2Department of Psychology, Stress Research Institute,
Stockholm University, Stockholm, Sweden
Objectives/Introduction: The brain undergoes substantial func-
tional reorganization of processes while changing from sleep to
being wake. This period of sleep inertia is likely to interfere with
memory functions, and the ability to later remember episodes oc-
curring during short wake periods. We determined I) whether the
ability to encode new information is related to the sleep stage one is
awakened from and II) how duration between waking up and encod-
ing new information affects memory performance.
Methods: A total of 31 healthy volunteers underwent two study
nights with polysomnography in a sleep laboratory. Each study night
participants’ performed five episodic memory tests (word recog-
nition) presented in randomized order (test position) within a test
battery spanning approx. 14 mins. The test battery was carried out
 |
106 of 356       ABSTRACTS
(condition): 1 hour prior to habitual bedtime (baseline), and four
times directly after waking up from different sleep (from SWS, N2,
REM). 1 hour after final awakening each participant was tested on
all previously encoded target words. We analyzed the proportion of
correctly recognized targets based on condition and test position
using mixed effects polynomial regression modeling.
Results: Linear mixed effects modeling revealed a significant
main effect of condition (baseline  =  0.72 [0.65 to 078], p < 0.001;
N2  =  −0.20 [−0.28 to −0.11], p  <  0.001; REM  =  −0.13 [−0.21 to
−0.04], p = 0.003; SWS = −0.23 [−0.31 to −0.14], p < 0.001) as well
as test position (test position2 = −0.86 [−1.33 to −0.39]. p < 0.001).
Conclusions: The ability to correctly remember previously encoded
target words appears to be impaired when waking up from sleep ir-
respective of the sleep stage one wakes up from. Additionally, over
a time span of approx. 14 mins, memory performance is worst when
encoding takes place immediately after waking up, improves with
time and declines again after about 10 mins.
Disclosure: Nothing to disclose.
P75 | Complete sleep and local field potential
analysis regarding estrus cycle, pregnancy,
postpartum and post-­weaning periods and
homeostatic sleep regulation in female rats
A. Tóth; M. Pethő; D. Keserű; D. Simon; T. Hajnik; L. Détári;
Á. Dobolyi
Department of Physiology and Neurobiology, Eötvös University,
Institute of Biology, Budapest, Hungary
Objectives/Introduction: Changes in the brain associated with preg-
nancy (PREG) and lactation are being increasingly recognized. Sleep
disturbances remained frequent both during PREG and the postpar-
tum (PP) period in mothers and may affect the development of the
fetus and the maternal emotional state.
Methods: Sleep and local field potential (LFP) characteristics were
addressed during the reproductive cycle in female rats using long-­
term (60–70 days) recordings (n = 10). Homeostatic sleep regulation
was tested by sleep deprivation (SDep). The effect of mother-­pup
separation on sleep was also investigated during the postpartum
(PP) period.
Results: First half of the pregnancy and early PP period showed in-
creased wakefulness (W) and higher arousal indicated by elevated
beta and gamma activity (p < 0.05). Slow wave sleep (SWS) recovery
was suppressed (p < 0.05) while REM sleep replacement was com-
plete after SDep in the PP period. Pup separation decreased mater-
nal W during early-­, but increased during middle PP while did not
affect during late PP (p < 0.05). More W, less SWS, higher light phase
beta activity but lower gamma activity (p < 0.05) was seen during the
post-­weaning estrus cycle compared to the virgin one.
Maternal sleep can be governed by the fetuses/pups needs and their
presence, which elevate W of mothers. Complete REM sleep-­and
incomplete SWS replacement after SDep in the PP period may re-
flect the necessity of maternal REM sleep for the offspring while
SWS increase may compete with W essential for maternal care.
Maternal experience may cause sleep and LFP changes in the post-­
weaning estrus cycle.
Conclusions: PREG represents a crucial point in female sleep regula-
tion. As time progresses, needs of the fetuses and later of the pups
may increasingly dominate the actual needs of the mother. Maternal
sleep changes during PREG and the PP period may reflect this con-
flict between the intrinsic sleep needs and the actual sleep, which is
allowed to be expressed in the presence of the pups. Reduced ho-
meostatic sleep drive may enable more W, which is needed for the
expression of maternal behavior.
Disclosure: Nothing to disclose.
P76 | Reindeer (Rangifer tarandus) sleep can be
measured by non-­invasive electroencephalography
M. Furrer1; S. Meier2; R. Huber1,3; S.A. Brown2; G.C.
Wagner4,5
1
Child Development Center, University Children's Hospital Zurich;
2
Institute of Pharmacology and Toxicology, University of Zurich;
3
Department of Child and Adolescent Psychiatry and Psychotherapy,
Psychiatric Hospital Zurich, Zurich, Switzerland; 4Department of Arctic
and Marine Biology, UiT—The Arctic University of Norway; 5Division
of Forest and Forest Resources, Norwegian Institute of Bioeconomy
Research, Tromsø, Norway
Objectives/Introduction: Reindeer have evolved exceptional strat-
egies to cope with the extreme light conditions in the Arctic, in-
cluding the absence of circadian behavior in summer and winter.
Nevertheless, to our knowledge reindeer sleep has never been stud-
ied by electroencephalography (EEG). Our goal was to test the feasi-
bility of non-­invasive EEG in Norwegian reindeer (Rangifer tarandus
tarandus).
Methods: We simultaneously recorded non-­
invasive EEG and
video in four adult, female reindeer held in an animal facility at the
University of Tromsø. All procedures were performed without anes-
thesia. Recordings started in the late afternoon and lasted approxi-
mately six hours (3.61 ± 0.1 hours light, 2.53 ± 0.55 hours darkness,
mean ± STD). Non-­rapid (NREM) and rapid eye movement (REM)
sleep stages as well as eating and rumination were visually identi-
fied from EEG and video data. EEG sleep spindles were detected
automatically.
Results: The animals tolerated our method well. We obtained al-
most artefact-­
free EEG data from all animals. Reindeer spent
18.79 ± 5.42% of total sleep time in REM sleep and all animals were
more asleep during the dark (41.83 ± 7.55%) than the light period
(23.82 ± 3.25%, p = 0.04). During NREM sleep, typical EEG character-
istics, such as slow waves and sleep spindles, were present. Per min-
ute of NREM sleep, 6.69 ± 0.44 sleep spindles with a mean duration
ABSTRACTS
of 0.93 ± 0.08 seconds and a mean frequency of 14.44 ± 0.12 Hz
were detected. In accordance with other studies measuring EEG in
ruminants, most of the time spent ruminating, reindeer showed si-
multaneously characteristics of NREM sleep. Interestingly, our pre-
liminary analyses indicate that slow-­wave activity, a marker of sleep
pressure, decreases during this state. If true, expanded summertime
rumination might permit an apparent reduction in sleep behavior
during this season.
Conclusions: We successfully measured reindeer sleep by non-­
invasive EEG. The high proportion of REM sleep as compared to
other ruminants suggests that the animals were not extensively
stressed by the study setup. Future projects will focus on sleep
across the four seasons to study its relationship with the reindeer's
circadian system.
Disclosure: Nothing to disclose.
P77 | A sleep behaviour intervention to
improve cardiometabolic health in individuals
with overweight and obesity: a randomized
controlled trial
R.H.P. Henst1; L.C. Roden2; D.E. Rae1
1 2
University of Cape Town, Cape Town, South Africa; Coventry
University, Coventry, United Kingdom
Objectives/Introduction: Cardiometabolic diseases (CMD) pose a
major health burden on the global population, and over the fol-
lowing decades cardiometabolic morbidity and mortality rates
are expected to increase further. Sleep duration, sleep fragmen-
tation, sleep timing and sleep architecture have been associated
with cardiometabolic health and obesity, and warrant exploration
as targets for reducing CMD risk. The purpose of this study was
to measure the effects of a sleep behaviour intervention within an
8-­week lifestyle intervention programme on sleep and cardiomet-
abolic health in individuals with overweight and obesity, and to
determine whether changes in sleep were associated with changes
in cardiometabolic health.
Methods: Body mass index, waist-­
circumference, waist-­
to-­
height
ratio, total body fat, blood pressure (BP), fasting measures of in-
sulin resistance, lipids, resting metabolic rate (RMR) and habitual
sleep characteristics (questionnaire and actigraphy) of overweight
and obese participants of a lifestyle intervention programme were
randomly assigned to undergo a sleep behaviour intervention (SBI)
or not (CON), and were assessed and compared at baseline and
8 weeks later at follow-­up.
Results: The SBI group (n = 15) demonstrated earlier get-­up times
(effect-­size, ES: −0.811, p  =  0.035) and midpoints of sleep (ES:
−0.815, p = 0.034) than the CON group (n = 15) in response to the in-
tervention. Changes in sleep duration, sleep fragmentation or sleep
timing were not different between the SBI and CON groups. Systolic
BP (ES: 0.627, p = 0.039) and RMR (ES: 1.110, p = 0.007) increased,
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and glycated haemoglobin (HbA1c) decreased (ES: −0.784, p = 0.049)
in the SBI group over the course of the programme. Furthermore,
with the SBI and CON groups combined, change in total cholesterol
(TC) and change in RMR correlated with change in simplified sleep
regularity index (TC: ⍴=0.565, p  =  0.002, n = 27; RMR: ⍴=0.612,
p < 0.001, n = 27).
Conclusions: The findings of this study support a role for sleep im-
provement strategies to better cardiometabolic health, and suggest
that HbA1c, RMR and systolic BP may be more sensitive to changes
in sleep timing than anthropometric measures and lipids. Further
research is needed to confirm the findings of the present study in
alternative settings, and to determine how participants who may
benefit from a sleep behaviour intervention for the betterment of
cardiometabolic health may be identified.
Disclosure: Nothing to disclose.
P78 | Mapping changes in delta band power
following auditory stimulation targeting slow
wave up-­and down-­phases: a source-­localization
study
E. Krugliakova1; J. Skorucak1; G. Sousouri1,2; S. Leach1; L.
Ferster2; G. Da Poian2; W. Karlen2; R. Huber1,3
1
Child Development Center, University Children's Hospital Zurich,
Zürich; 2Mobile Health Systems Lab, Institute for Robotics and
Intelligent Systems, Department of Health Sciences and Technology,
ETH Zurich; 3Department of Child and Adolescent Psychiatry and
Psychotherapy, Psychiatric Hospital University of Zurich, Zurich,
Switzerland
Objectives/Introduction: Recently it was demonstrated that it is
possible to manipulate delta power during NREM sleep within a par-
ticular brain region by means of phase-­t argeted auditory stimulation
(Fattinger et al., 2017). Here we explore the differential effect of
auditory stimulation targeting up-­and down-­phases of slow waves
on the neural sources of delta power.
Methods: In an ongoing study, we collect sleep hd-­EEG data of 12
participants (~23y, 6 men). Three conditions separated by 1 week are
carried out: (1) non-­stimulation (SHAM), auditory stimulation in (2)
the up-­phase (upSTIM) or (3) the down-­phase (downSTIM) of slow
waves over the right prefrontal area. During the stimulation, pink
(1/f) noise pulses are delivered in 6-­s blocks (ON-­windows), followed
by a 6-­s pause (OFF-­windows). Power in the low delta (0.75–2 Hz)
frequency band was compared between ON-­and OFF-­windows.
Source localization was performed using dynamic imaging of coher-
ent sources (DICS).
Results: Here we present preliminary results for 9 participants.
When comparing delta power in upSTIM and downSTIM vs SHAM
for ON-­and OFF-­windows separately, we observed a fronto-­central
enhancement of power (+20%; p = 0.03) for ON-­windows in upSTIM
as compared to SHAM but no difference for downSTIM compared to
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108 of 356       ABSTRACTS
SHAM. However, there was a significant decrease in power for OFF-­
windows in downSTIM as compared to SHAM (−25%; p < 0.002).
Source estimates of these differences revealed a symmetric involve-
ment of the orbitofrontal cortices in upSTIM. A symmetric involve-
ment in downSTIM was found for the cingulate cortices, but the
decrease in fronto-­central areas was limited to the right hemisphere.
Conclusions: Auditory stimulation targeting the up-­phase of slow
waves enhanced activity in the delta band as previously shown.
Despite the location of the detection electrode over the right pre-
frontal cortex, we observed a symmetric orbitofrontal delta en-
hancement. This lack of lateralization might be explained by the
high synchronicity of emerging thalamocortical slow waves for the
two hemispheres. Notably, the decrease observed for down-­phase
stimulation was lateralized: the right hemisphere was involved to a
greater extent. Overall, our results suggest distinct mechanisms un-
derlying the effects of up-­and down-­phase stimulation.
Disclosure: Nothing to disclose.
P79 | Role of sleep in the dephosphorylation
of brain Tau protein following synthetic torpor in
the rat
T. Hitrec1; M. Cerri1,2; M. Luppi1; C. Maggiorano1; D.
Martelli1; A. Occhinegro1; E. Piscitiello1; F. Squarcio1; D.
Tupone1; R. Amici1
1
Department of Biomedical and Neuromotor Sciences, Alma Mater
Studiorum -­University of Bologna; 2National Institute of Nuclear
Physics, Bologna, Italy
Objectives/Introduction: Torpor/hibernation (TH) is a hypometa-
bolic state characterized by a strong reduction in body temperature.
During TH, a large and reversible accumulation of hyperphosphoryl-
ated Tau protein (pTau) in the brain has been described, a process
that may be associated with synaptic remodelling. Exit from TH is
always followed by a sleep bout with high-­intensity Delta activity,
which is concomitant with pTau dephosphorylation. These pro-
cesses have also been described in rats (non-­hibernating mammals)
undergoing synthetic torpor (ST), a hypometabolic state induced
by the inhibition of the key thermoregulatory area Raphe Pallidus
(Rpa). Aim of the study was to assess the contribution of sleep to
the dephosphorylation process of pTau, by suppressing the post-­ST
sleep bout in the rat.
Methods: Fifteen male Sprague-­Dawley rats were implanted under
general anaesthesia with electrodes for electroencephalographic
recording, a microcannula within the RPa, and an intracerebral ther-
mistor. ST was achieved by means of multiple microinjections of
muscimol (GABA-­A agonist) within the RPa. Following a one-­week
recovery, rats were anaesthetized and transcardially perfused with
paraformaldehyde (4%), the brain excised and processed for immu-
nohistochemistry. Experimental conditions studied were: i) Control
(C, vehicle injected into the RPa, n = 2); ii) Hypothermic nadir of ST
(N, 6 h after the start of muscimol microinjections, n = 3); iii) Early re-
covery (ER, when euthermia was reached after ST, n = 4); iv) 6 h after
ER, during which animals were allowed to sleep (6 h-­S, n = 4); v) 6 h
after ER, during which animals were sleep deprived by gentle han-
dling (6 h-­SD, n = 2). pTau (anti-­AT8, phospho-­Ser202/Thr205) was
quantified in the following brain structures: locus coeruleus, lateral
parabrachial nucleus, paraventricular nucleus of the hypothalamus,
median preoptic nucleus, ventrolateral preoptic nucleus, CA3 field
of the hippocampus, and parietal cortex (p-­Cx).
Results: The results confirm the reversible widespread presence of
pTau induced by ST. A significantly larger amount of pTau was ob-
served in p-­Cx in 6 h-­SD compared to 6 h-­S (Mann-­Whitney test,
p < 0.05), while no significant differences were observed in the other
structures.
Conclusions: Sleep following the return to euthermia after a ST
seems to play a role in favoring pTau dephosphorylation in the p-­Cx.
This supports a role for sleep in brain plasticity at cortical level.
Disclosure: Nothing to disclose.
P80 | Conditional deletion of miRNA in
hypocretin neurons: a new mouse model of
narcolepsy
M.-L. Possovre; M. Tafti
Département des Sciences Biomédicales, Université de Lausanne,
Lausanne, Switzerland
Objectives/Introduction: The cause of loss of hypocretin (HCRT)
neurons in human narcolepsy with cataplexy is unknown. Whether
HCRT neurons are destroyed or silenced by epigenetic means such
as through miRNA regulation, is unknown. miRNAs are small, non-­
coding and highly conserved RNAs. They have several roles such as
cleavage of target mRNA to regulate protein synthesis. To be func-
tional miRNAs must be processed by the protein DICER.
Methods: Here we produced conditional Hcrt-­DICER mice by cross-
ing Hcrt-­Cre with DICER-­Flox mice.
Results: The conditional mice (n = 9) present a typical narcolepsy
with cataplexy phenotype compare to control mice (n = 11) due to
the absence of HCRT neurons in the lateral hypothalamus. This find-
ing indicates that germline deletion of DICER in HCRT neurons leads
to developmental or toxic ablation of HCRT neurons. To further elu-
cidate the role of miRNAs two series of experiments are ongoing.
First DICER is conditionally deleted by unilateral hypothalamic injec-
tion of a Cre-­expression AAV in mice at 9 weeks of age. Preliminary
results in adult mice indicate a decrease in the number of HCRT neu-
rons in injected DICER Flox-­Flox mice (n = 4) vs control mice (n = 4,
C57BL/6J).
Conclusions: To be more specific to HCRT neurons, in the second
series of experiments, Hcrt-­tTA-­Cre mice are crossed with DICER-­
Flox mice and TetO-­Cre mice. In these 3-­way transgenic mice, DICER
will be deleted in HCRT neurons at 3 and 9 weeks of age by removing
ABSTRACTS
Tetracycline.The presence of HCRT neurons and the narcolepsy
phenotype will be investigated.
Disclosure: Nothing to disclose.
P81 | Chronic intermittent hypoxia relates
to low levels of circulating soluble low-­density
lipoprotein receptor-­related protein 1
A. Bikov1; M. Meszaros2
1
Manchester University NHS Foundation Trust, Manchester, United
Kingdom; 2Department of Pulmonology, Semmelweis University,
Budapest, Hungary
Objectives/Introduction: Chronic intermittent hypoxia (CIH) in
obstructive sleep apnoea (OSA) is related to dyslipidaemia. Low-­
density lipoprotein receptor-­related protein 1 is involved in the low-­
density lipoprotein (LDL) uptake and its soluble levels (sLRP-­1) can
be measured in plasma samples. The aim of our study was to analyse
fasting plasma sLRP-­1 levels in patients with suspected obstructive
sleep apnoea.
Methods: Seventy-­
six volunteers (38 men, 50 ± 14 years) were
recruited. None of the patients had been diagnosed with OSA or
dyslipidaemia before. During their admission for an inpatient sleep
study, fasting blood has been collected for sLRP-­1, total cholesterol,
LDL-­cholesterol, high-­density lipoprotein cholesterol (HDL-­C) and
triglyceride levels. sLRP-­1 levels were correlated with demographics,
lipid profile, clinical and sleep parameters.
Results: Forty-­five participants were diagnosed with OSA and they
tended to have lower sLRP-­1 levels (1.64 /0.89–2.14/ vs. 1.95 /1.49–
3.51/ mg/L, p = 0.06). Plasma sLRP-­1 concentrations were inversely
related to age (r  =  −0.29), BMI (r  =  −0.35), cigarette pack years
(r = −0.31), LDL-­C (r = −0.34) and triglyceride levels (r = −0.27) as well
as the oxygen desaturation index (ODI, r = −0.24). Using multivariate
regression analysis only BMI (p = 0.01) and ODI (p = 0.04) remained
to be significant predictors for low sLRP-­
1 levels. Interestingly,
plasma sLRP-­1 did not correlate with the apnoea-­hypopnoea index
or arousal index, suggesting that CIH rather than sleep fragmenta-
tion contributed to our findings.
Conclusions: Chronic intermittent hypoxia may reduce the expres-
sion of LRP-­1 which may lead to higher serum LDL-­C and triglyceride
levels. Our study highlights a potential mechanism of dyslipidaemia
in OSA.
Disclosure: Nothing to disclose.
|
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P82 | Predictors of impaired cerebral perfusion
and cerebral desaturation in patients with
obstructive sleep apnea syndrome
Z. Zhang1; M. Qi1; G. Hügli1; R. Khatami1,2
1
Center for Sleep Medicine and Sleep Research, Clinic Barmelweid AG,
Barmelweid; 2Department of Neurology, Inselspital, Bern University
Hospital and University of Bern, Bern, Switzerland
Objectives/Introduction: Obstructive sleep apnea syndrome (OSAS)
can damage the cerebral autoregulation and lead to cerebrovascular
diseases like hypertension and stroke. Understanding the regulation
mechanisms of the repetitive changes in cerebral perfusion and oxy-
genation triggered by obstructive sleep apneas/hypopneas is crucial
for the assessment of disease severity and treatment. Using a step-
wise increment continuous positive airway pressure (CPAP) titration
protocol we aim to identify the most relevant physiological factors
and their quantitative contributions to the induced cerebral hemo-
dynamic changes in patients with OSAS.
Methods: 27 OSAS patients (age [mean  ±  standard deviation]:
53.4  ±  13.3  years; male: 25; Body Mass Index [BMI]: 35.6  ±  7.1;
apnea/hypopnea index [AHI]: 54.7 ± 24.6/h) underwent CPAP titra-
tion during polysomnography recordings: 1-­h baseline sleep with-
out CPAP followed by stepwise increment of 1-­cmH2O pressure
per-­hour starting from 5–8 cmH2O individually. Frequency-­domain
near-­infrared spectroscopy measured the changes in blood volume
(BV) and oxygen saturation (StO2) in the left forehead. Age, sex,
BMI, sleep stages, sleep positions, types and durations of respiratory
events, mean heart rate (HR) during events, CPAP pressures and the
AHI/arousal-­index/leg-­movement-­index under different CPAP pres-
sures were included to predict the coefficients of variation of BV
(CV-­BV) and the decreases of StO2 (de-­StO2) caused by the respira-
tory events using linear mixed-­effect models, respectively. The best
predictors were selected by stepwise regression.
Results: 2011 and 2018 apnea/hypopnea events were used to fit
the models for CV-­BV and de-­StO2, respectively. Longer events
caused larger changes in CV-­BV (p < 0.0001) and decreases in StO2
(p < 0.0001). The events with larger baseline StO2 before their
onsets (both models gave p < 0.001), higher HR during the events
(p < 0.001, p = 0.0035), occur in rapid-­eye-­movement (REM) sleep
(p = 0.018, p = 0.0048) trigger smaller changes in CV-­BV and de-­StO2.
Obstructive apneas induce larger changes in CV-­BV (p < 0.0001) and
de-­StO2 (p < 0.001) than hypopneas.
Conclusions: The length of respiratory event may indicate the sever-
ity of cerebral vascular damage in OSAS. In addition to the event's in-
herent features (i.e., durations and the types of event), brain activity
(sleep stages and baseline oxygen saturation) and systemic HR also
contribute to the induced changes in cerebral perfusion and desatu-
ration by obstructive apnea and hypopnea events.
Disclosure: Nothing to disclose.
 |
110 of 356       ABSTRACTS
P83 | Effect of CPAP treatment on
cardiovascular outcomes in adults with acute
coronary syndrome and nonsleepy obstructive
sleep apnoea: a secondary analysis of the
RICCADSA trial
Y. Peker 1,2,3 2 4
; E. Thunström ; H. Glantz ; C. Eulenburg 5 Baptista; A. Craveiro; D. Rocha; E. Magalhães; M.J. Valente;
1
Koc University Research Center for Translational Medicine (KUTTAM),
Istanbul, Turkey; 2University of Gothenburg Sahlgrenska Academy,
3
Gothenburg, Sweden; University of Pittsburgh School of Medicine,
Pittsburgh, PA, United States; 4Dept of Internal Medicine, Skaraborg
Hospital, Lidköping, Sweden; 5Dept for Epidemiology, University of
Groningen, Groningen, The Netherlands
Objectives/Introduction: There′s a controversy within the research
field regarding the prognostic value of obstructive sleep apnoea
(OSA) and its treatment in patients with acute coronary syndrome
(ACS) after the recent report from the ISAACC trial. We addressed
the effect of auto-­
titrating continuous positive airway pressure
(CPAP) on major adverse cardiovascular and cerebrovascular events
(MACCEs) in adults with ACS and concomitant OSA without exces-
sive daytime sleepiness.
Methods: The current study was a secondary analysis of the
ACS subgroup of the RICCADSA trial, conducted in Sweden be-
tween 2005 and 2013. Participants with nonsleepy OSA (apnoea-­
hypopnoea-­index [AHI]≥15 events/h on a home sleep apnoea
testing, and Epworth Sleepiness Scale [ESS] score < 10; n = 171) were
randomized to CPAP (n = 86) or no-­CPAP (n = 85). The sleep stud-
ies were performed after a median of 56 days (interquartile range
[IQR] 36.5 – 76.0 days) following the revascularization. The primary
endpoint was the first MACCE (repeat revascularization, myocardial
infarction, stroke or cardiovascular mortality).
Results: The incidence of the primary endpoint did not differ sig-
nificantly in nonsleepy OSA patients who did versus did not re-
ceive CPAP (5.47 vs. 5.05 per 100 person-­years; hazard ratio [HR]
0.94; 95% confidence interval [CI] 0.49–1.79; p = 0.85) in intention-­
to-­treat analysis. The average CPAP use was 3.53 ± 3.31 h/day at
2 year-­follow-­up. On-­treatment analysis showed a significant risk re-
duction in those who used CPAP for ≥ 4 versus < 4 h/day or did not
receive treatment (adjusted HR 0.17; 95% CI 0.03–0.81; p = 0.03).
Conclusions: Routine CPAP prescription to nonsleepy OSA pa-
tients does not reduce this risk when compliance is not considered.
Adequate use of CPAP may reduce long-­term adverse outcomes in
ACS patients with nonsleepy OSA.
Trial registration: The RICCADSA trial was registered with
ClinicalTrials.gov (NCT 00519597).
Disclosure: The Swedish Research Council, the Swedish Heart-­Lung
Foundation, and ResMed Foundation.
P84 | Retrospective analysis of inconclusive
cardiorespiratory sleep studies with worsening
classification of obstructive sleep apnea/
hypopnea syndrome on polysomnography
S. Costa-Martins; A. Pereira; I. Vicente; J. Barata; M.
M.S. Valente
Centro Hospitalar Universitário Cova da Beira, Covilhã, Portugal
Objectives/Introduction: Cardiorespiratory Sleep Study (CSS) is ad-
equate in detecting Obstructive Sleep Apnea/Hypopnea Syndrome
(OSAHS) in selected patients. However, this test can present false-­
negatives results with therapeutic and diagnostic consequences.
This study aims to verify in which aspects are different those pa-
tients that present disagreement in the classification of OSAHS be-
tween a CSS and a polysomnography (PSG) attended in-­laboratory.
Methods: All patients that underwent PSG after a CSS with an apnea
hypopnea index (AHI) under 15 events, between 2009 and 2019
were included in this retrospective observational study. The patients
were grouped depending whether the results of the two tests were
divergent in severity of OSAHS (Group A) or identical (Group B). The
data was subjected to a comparative analysis between group A and
group B. It was considered as a worsening of OSAHS when there was
a difference of at least 10 respiratory events per hour.
Results: A total of 236 patients were included in the study. 102
(43%) displayed an aggravation in their OSAHS classification when
submitted to PSG in comparison to their previous CSS. The mean
difference in respiratory disturbance index (RDI) and AHI was 21
respiratory disturbances per hour. Group A was primarily composed
of men (76%) with a mean age of 56 (vs 52 in group B) and presented
a statistically significant (p < 0.05)greater number of hypopneas,
mixed apneas, and snoring time, as well as a greater oxygen desatu-
ration index (ODI) independent of study type. Regarding sleep ar-
chitecture, these patients showed a reduction in slow-­wave sleep
and REM sleep, they also had a higher count of micro-­arousals than
group B. Both groups were similar in terms of body mass index, day-
time sleepiness, reduced sleep efficiency, total time in bed and total
sleep.
Conclusions: Male individuals, over 55 years old, a greater number
of hypopneas and snoring time had an underestimated AHI in CSS.
In patients with these characteristics and suspected REM sleep sup-
pression, the hypothesis of a more severe OSAHS than that reported
in an outpatient study should always be considered. Other clinical
factors should be investigated in order to anticipate a false-­negative
result that justifies PSG for diagnostic confirmation.
Disclosure: Nothing to disclose.
ABSTRACTS
P85 | Maternal sleep apnea and fetal heart rate
monitoring
I. Madaeva; O. Berdina; N. Sachianova; L. Rychkova
Scientific Centre for Family Health and Human Reproduction Problems,
Irkutsk, Russian Federation
Objectives/Introduction: Obstructive sleep apnea (OSA) is charac-
terized by episodic nocturnal airflow limitations that cause intermit-
tent hypoxia. To date, some studies have investigated maternal OSA
as risk factor for fetal status abnormalities and newborn disadap-
tation, but reported findings were not similar. The purpose of our
study was to explore fetal heart rate monitoring (FHM) abnormali-
ties in OSA pregnant women.
Methods: A cross-­
sectional study of 22 pregnant women in
34–36 weeks of gestation who had polysomnography (PSG) to diag-
nosis OSA. 13 participants were identified as apneic. All women under-
went standard external FHM simultaneously with PSG using Touti-­320
system. FHM characteristics as basal heart rate (HR), oscillation ampli-
tude and frequency (OA and OF), number of accelerations (AN), decel-
erations (DN), and fetal movements (FM) were compared.
Results: FHM revealed changes of FHM variables in early morning
hours in 59.2% of OSA pregnant women vs. 23.1% in the non-­OSA
sample (p = 0.031). The pathological type of FTM was recorded in
25.5% in the OSA group only. So, fetuses in OSA pregnant women
showed a statistically significant increasing of the average basal HR
(154.20 ± 1.27 beats/min vs. 143.61 ± 1.11 beats/min in the non-­OSA
group, p = 0.042), number of FM (14.6 ± 1.3 n/30 min vs. 11.8 ± 1.1
n/30 min, respectively, p = 0.017) and the tendency to increasing of
DN (0.22 ± 0.01 n/30 min vs. 0.12 ± 0.01, n/30 min, in the non-­apneic
women, p = 0.632), but reduction of OA (6.91 ± 0.51, min vs. 9.24 ± 0.44,
min, respectively, p = 0.021). Also, all fetuses in OSA mothers showed
HR variability in the form of bradycardia or tachycardia relatively basal
HR during apnea episodes.
Conclusions: The results of FHM suggest that fetuses respond to
maternal hypoxia during apneic episodes by cardiac activity changes,
which should be considered as an adaptive reaction. If maternal OSA
remains untreated, failure of adaptive mechanisms may occur with
adverse outcomes for the fetus and newborn. Further researches
are needed to determine the vector of timely prevention of diseases
and deviations in childhood health, born from OSA mothers.
Disclosure: Nothing to disclose.
|
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P86 | Changes in sleep pattern in mothers and
their children during COVID-­19 lockdown in Italy
N. Cellini1,2,3; G. Mioni1; D. Di Riso 4; E. Di Giorgio 4
1
Department of General Psychology; 2Department of Biomedical
Sciences; 3Padova Neuroscience Center; 4Department of
Developmental Psychology and Socialisation, University of Padova,
Padova, Italy
Objectives/Introduction: Italy has been the first western country
to introduce, by March 10th, a total lockdown to reduce COVID-­19
outbreak. The lockdown has challenged people's daily rhythms, par-
ticularly for mothers and their children. Here, we investigated the
impact of home confinement on sleep patterns of mothers and their
children.
Methods: An online survey, that involved families with children aging
2–5y, was administered to 245 mothers (Mage = 37.31 ± 4.62y) from
April 1st to April 9th, 2020. Mothers had to think about on their hab-
its, behaviors, and emotions, and on those of their youngest children
(Mage = 4.10 ± 0.92y) during and, retrospectively, a week before
the national lockdown (i.e., late February). Mothers’ sleep pattern
was assessed using Pittsburgh Sleep Quality Index (PSQI) whereas
children’ sleep was assessed using the Sleep Disturbance Scale for
Children and two additional questions about children bed-­and wa-
ketime. We also measured the Inhibitory Self-­Control Index from the
Behavior Rating Inventory of Executive Functions.
Results: Sleep timing was markedly affected by the lockdown both
in mothers and in children. During lockdown, mothers went to bed
and woke up ~54 min and ~57 min later than before lockdown
(p's  < 0.0001), respectively. Mothers’ sleep got worse during lock-
down (p < 0.0001). The proportion of mothers reporting poor sleep
(PSQI > 5) increased from 21.54% before the lockdown to 48.37%
(p = 0.001). Changes in mothers’ sleep timing and quality were lin-
early associated with changes in children, who went to bed and woke
up ~53 min and ~66 min later (p < 0.0001). Children showed worsen-
ing inhibitory self-­control (p = 0.007) and, although their sleep qual-
ity did not significantly change at the group level (p = 0.970), children
with worse sleep quality change showed increased inhibitory self-­
control difficulties (p < 0.0001).
Conclusions: The lockdown challenged mothers′ and children’ sleep
quality and timing, in particular for mothers who were forced to
stop working or work from home. Changes in children’ sleep were
associated with worse behavioral self-­regulation. This data suggests
that home confinement, although necessary for reducing COVID-­19
spread, markedly affected sleep and well-­being of mothers and their
children. Considering the risk of future pandemic outbreaks, both
national institutions and healthcare systems need to timely develop
strategies to support families′ physical and mental health.
Disclosure: This work is supported by the University of Padova
under the STARS Grants program to N.C. The present work was
carried out within the scope of the research program ‘Dipartimenti
112 of 356       |
di Eccellenza’, which is supported by a grant from MIUR to the
Department of General Psychology, University of Padua.
P87 | The relation between sleep spindle
power and emotion regulation across
development
1 1 2 1
K. Bothe ; M. Hahn ; I. Wilhelm ; K. Hoedlmoser
1
Laboratory for Sleep, Cognition and Consciousness Research, Centre
for Cognitive Neuroscience, University of Salzburg, Salzburg, Austria;
2
Translational Psychiatry Unit (TPU), Department of Psychiatry and
Psychotherapy, University of Lübeck, Lübeck, Germany
Objectives/Introduction: Emotion regulation (ER) refers to the abil-
ity to modulate emotional experiences or emotion expression. Poor
ER is a contributing factor to the onset/maintenance of psychiatric
disorders. First evidence suggests that sleep alterations are also re-
lated to the development and/or persistence of mood and anxiety
disorders in children, adolescents, and adults. Most recently, it has
been shown that sleep spindle activity is associated with ER in chil-
dren and adolescents suffering from affective disorders. However,
less is known about the association between sleep spindles and ER
in healthy participants within this age group.
Methods: We re-­analyzed longitudinal data (27 healthy subjects (18
females) at two time points (childhood mean age: 9.48 ± 0.75; ado-
lescence mean age: 16.00 ± 0.92) by correlating polysomnographic
recordings during sleep (NREM 2 slow (9–12 Hz) and fast (13–16 Hz)
sleep spindle power, fast Fourier transformation, Hanning window,
averages of five 4 s epochs, frequency resolution 0.25 Hz; frontal,
central, parietal and occipital derivations) with several measures of
ER (i.e. ‘emotional problem’ scale from the strengths and difficulties
questionnaire (SDQ); ‘anxious/depressed’, ‘withdrawn’, and ‘inter-
nalizing problems’ scales from the Child behavior checklist -­CBCL).
Moreover, we calculated a slow to fast spindle power ratio as an indi-
cator for the dynamics of slow and fast spindle power development.
Results: In adolescents, higher slow but not fast spindle power at
frontal and central sites was associated with better ER, i.e. lower
values on the ‘emotional problems’ scale (frontal: r(24)  =  −0.51,
p = 0.008; central: r(24) = −0.42, p = 0.032). Furthermore, higher slow
as compared to fast spindle power over frontal and central sites was
related to better ER in adolescents (p between 0.003 and 0.045 for
all ER scales). Spindle power was not significantly associated with ER
during childhood (all p > 0.141) and spindle power during childhood
did also not correlate with ER during adolescence (all p > 0.125).
Conclusions: Our results support previous findings from clinical
adolescent samples and suggest that (slow) sleep spindle power is
related to ER abilities in healthy adolescents. Thus, our results em-
phasize the role of sleep spindle activity as a useful marker for ER
during adolescence.
Disclosure: Nothing to disclose.
ABSTRACTS
P88 | Insomnia and behavioural and cognitive
functioning in children with attention deficit
hyperactivity disorder -­a case-­control study
X. Li1; K.S.C. Shea2; W.V. Chiu1; L.F. Lau1; C.K.D. Wong1;
W.M.M. Yu3; A.M. Li4; Y.K. Wing3; Y.C.K. Lai3; S.X. Li1,5
1
Psychology, The University of Hong Kong; 2Psychiatry, Alice Ho
Miu Ling Nethersole Hospital; 3Psychiatry; 4Pediatrics, The Chinese
University of Hong Kong; 5The State Key Laboratory of Brain and
Cognitive Sciences, The University of Hong Kong, Hong Kong, Hong
Kong
Objectives/Introduction: Although insomnia is common in children
with attention deficit hyperactivity disorder (ADHD) and is known
to have a negative impact on cognitive functioning in children, there
has been limited research with mixed findings on the behavioural
and cognitive functioning in children with ADHD and comorbid in-
somnia. The aim of the current study was to compare behavioural
and cognitive functioning in ADHD children with insomnia, ADHD
children without insomnia and healthy controls (HC).
Methods: A total of 44 children with ADHD and comorbid insomnia,
22 ADHD children without insomnia and 22 age-­and sex-­matched
HC were recruited into this study (age range: 6–12 years, 73% male).
They were assessed by parent-­report questionnaires on sleep, be-
havioural problems and ADHD symptoms, and completed a battery
of cognitive tests including Digit Span test and N-­back task for work-
ing memory, Continuous Performance Test (CPT) for sustained at-
tention, Letter-­digit test for processing speed, and Tower of London
(TOL) test and Bergs Card Sorting Test (BCST) for executive function.
Results: Children with ADHD and comorbid insomnia had the high-
est SWAN total and inattention scores, followed by ADHD children
without insomnia and HC (both p < 0.05). After controlling for age,
sex, ADHD medication on assessment, and internalizing problems,
there were significant group differences, with ADHD children with
insomnia showing poorer performance on CPT (longer correct re-
action time (RT), p = 0.002), Letter-­digit test (longer RT, p = 0.006),
and BCST (less correct response on p = 0.029) as compared to their
counterparts. Multiple regression analyses showed a positive asso-
ciation between parent-­reported bedtime resistance and mean RT
on Letter-­digit test, St. β=0.25, p = 0.038, and a significant nega-
tive association of parent-­reported sleep onset delay with correct
responses on BCST, St. β  =  −0.28, p = 0.029, and a marginally sig-
nificant positive association with correct RT on CPT, St. β=0.20,
p = 0.089, in ADHD children.
Conclusions: Comorbid insomnia is associated with more severe
behavioural symptoms of inattention and cognitive impairments
in sustained attention, processing speed and executive function in
ADHD children. There is a need for longitudinal studies to explore
the long-­term impact of insomnia and the effects of sleep-­focused
intervention on cognitive functioning in ADHD children.
Disclosure: Nothing to disclose.
ABSTRACTS
P89 | Could polysomnography identify
potential SIDS/BRUE victims? Subtle changes in
arousability during sleep in healthy infants (SIDS:
Sudden infant death syndrome, BRUE: Brief
Resolved Unexplained Event)
M. Merino Andreu1; J. Oliva-Navarro1; M. Naranjo-
Castresana1; M.J. Aguilar Amat-Prior1; E. Herráez-
Sánchez1; B. Pastor-Romero1; M. Sánchez-Tornero1; A.
Martínez-Bermejo2
1
Department of Neurology; 2Department of Pediatric Neurology,
University Hospital La Paz, Madrid, Spain
Objectives/Introduction: Arousability is essential in neural con-
trol of sleep, not only as a biomarker of sleep disruption (Terzano
& Parrino, 1993) but also for survival in infants. A deficit in arousal
process has been implicated as a mechanism of sudden infant death
syndrome (SIDS) or brief resolved unexplained event (BRUE), with
fewer cortical arousals than control infants. The aim of this study
was to study the arousal characteristics in healthy infants, term and
preterm, to detect risk factors for SIDS or BRUE during the first
weeks of life.
Methods: Sixty-­t wo healthy infants, 30 term (TI) and 32 preterm in-
fants (PTI), were studied with daytime polysomnography after feed-
ing, whose reliability in this period requires a whole NREM/REM
cycle. We have analyzed cortical arousal and respiratory events
during different sleep stages, related with TI/PTI group, gestational
age (GA) and postconceptional age (PA), to assess the maturation
of arousals from birth. Sleep-­state and cardiorespiratory parameters
were scored, in all participants, usually supine sleepers, according to
recommended criteria (AASM).
Results: In these 62 infants, maturation of cortical arousal events
differed according to sleep states, with more REM sleep arousability
in higher PA (r = 0.262; p = 0.04), and according to its origin, with
more spontaneous microawakenings in TI group (p = 0.08), without
correlation with GA. Regarding respiratory events, maturity (GA
and PA) reduce central apnea-­hypopnea index (p < 0.029) and pe-
riodic breathing-­PB (p < 0.02), with less events in whole sleep and
significant shorter mean and maximal apnea-­
hypopnea duration
(p < 0.001).
Conclusions: In our study, during total sleep time, the frequency of
cortical arousals has not increased with maturation, as seen in REM
sleep, but longer apnea-­hypopnea duration in more immature in-
fants could reflect a subtle inability to alert after threatening events,
and persist. These polysomnographic findings show a certain imma-
turity of brainstem structures concerned in neural breathing control
and those involved in reactivity (reticular activating system-­R AS,
serotonergic), suggested as a mechanism of SIDS/BRUE, and iden-
tify potential victims.
Disclosure: Nothing to disclose.
|
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P90 | Time of day X chronotype effects on
adolescent's emotional states
C. Bettencourt1,2; L. Pires1,2,3; M.I. Clara1,2; B. Tomé1; J.A.
Leitão1,2; H.M.F. Cruz4; C.F. Silva5; M.H.P. Azevedo6; D.R.
Marques2,5; A. Allen Gomes1,2
1
Faculty of Psychology and Educational Sciences, University
of Coimbra; 2CINEICC -­FCT R&D Unit: Centre for Research in
Neuropsychology and Cognitive Behavioural Intervention, Coimbra,
Portugal; 3Department of Psychology, School of Life Sciences,
University of Hull, Hull, United Kingdom; 4Interdisciplinary Research
Centre for Education and Development (CeiED), University of Lusófona,
Lisbon; 5Department of Education and Psychology, University of
Aveiro, Aveiro; 6Faculty of Medicine, University of Coimbra, Coimbra,
Portugal
Objectives/Introduction: Puberty induces a shift in the circadian
rhythms’ phase. Chronotype influences behaviour and performance
throughout the day, with psychobehavioural variables such as emo-
tional states (ES) exhibiting circadian rhythmicity. However, the
interaction time of day X chronotype remains marginally explored,
particularly in adolescence. We investigated potential interactive ef-
fects of chronotype and time of day on adolescent's ES, hypothesiz-
ing that morning-­t ypes reveal a better mood in the early hours and
evening-­types experience it later in the day. We further probed it
while controlling for sleep (quantity and quality) and psychopatho-
logical symptoms (PS) due to its links with mood and ES.
Methods: One hundred ninety 8th-­
graders (53.7% males; mean
age 13.47 ± .70) completed a two-­part protocol: part one probing
chronotype, sleep, and PS; part two targeting four measures of ES
(momentary mood, positive and negative affect, and anxiety-­state)
while manipulating time of day (first and last hours of the school day
-­8:30 and 16:30). Potential confounders were considered, namely
PS and sleep-­related variables (sleep length, perceived sufficient
sleep, and sleep quality).
Results: Despite the hypothesized interaction not reaching signifi-
cance, consistent effects of time of day were uncovered on all ES’
measures, except for negative affect. Momentary mood (p < 0.001,
ηp2 = .125) and positive affect (p  <  0.001, ηp2 = .068) raised from
morning to afternoon and anxiety dropped (p = 0.001, ηp2 = .058).
Chronotype independently influenced all ES’ measures, except for
negative affect. Morning-­types showed better momentary mood
(p = 0.043, ηp2 = .033), more positive affect (p = 0.008, ηp2 = .051) and
less anxiety (p = 0.010, ηp2 = .048) than evening-­and intermediate-­
types. Chronotype's effect on ES’ measures seems to be influenced
by sleep and/or PS: effects on momentary mood and anxiety-­state
become non-­significant when controlling for sleep and PS, while ef-
fects on positive affect become non-­significant when controlling for
PS.
Conclusions: Chronotype and time of day exert independent effects
on adolescent's ES, although some associations between chrono-
type and ES seem to be influenced by sleep and/or PS. Overall, our
 |
114 of 356       ABSTRACTS
sample's adolescents revealed increased mood levels from first to
last hours of the school day regardless of chronotype.
Disclosure: All authors confirm that there are no conflicts of inter-
est associated with this publication. This work was developed under
the larger research project True Times -­Morningness-­eveningness
and time-­of-­day effects on cognitive performances and emotional
states: New lessons from children and adolescents (PTDC/PSI-­
ESP/32581/2017; CENTRO-­01-­0145-­FEDER-­032581), funded
by Portugal 2020, Centro 2020, FEDER (UE), and Portuguese
Foundation for Science and Technology (FCT).
P91 | Distinguishing sleep from wake with
a radar sensor: a contact-­free real-­time sleep
monitor for hospital rooms
H.S.A. Heglum1,2; D. Vethe3,4; H. Kallestad3,4; K. Langsrud3,4;
T. Sand1,5; M. Engstrøm1,5
1
Department of Neuromedicine and Movement Science, Norwegian
University of Science and Technology; 2Novelda AS; 3Department
of Mental Health, Norwegian University of Science and Technology;
4
Department of Psychiatry, St Olavs University Hospital, Trondheim;
5
Department of Neurology and Clinical Neurophysiology, St Olavs
University Hospital, Olav Kyrres Gate, Norway
Objectives/Introduction: Patients admitted to psychiatric hospitals
often experience sleep problems. However, since these patients
have limited tolerance for on-­body sensor equipment, assessment
of their sleep is often done solely by staff observations. This is at
once limited in reliability, a burden for the night staff, and a potential
disturbance to the patient.
In a newly built psychiatric hospital, a radar sensor has been installed
in the ceiling of all patient rooms. This sensor can detect a wide range
of body movements within an indoor environment, without requir-
ing direct physical contact. The use of body movement for sleep/
wake classification is common in clinical and research settings, in the
form of actigraphy. We hypothesized that the signals from the radar
could be used to distinguish sleep from wake in a similar way.
Methods: Twelve healthy young adults resided in the ward for two
weeks in a controlled trial. On a total of 48 nights simultaneous re-
cordings of sleep were conducted with polysomnography (PSG), ac-
tigraphy, and two radar sensors; one in the ceiling, and one placed
on a nightstand. We used this data set of homogenous healthy young
sleepers to develop and test a method for sleep/wake classification
for radar-­recorded activity data, based on principles commonly used
by actigraphy. We then further validated our method on a set of het-
erogenous patients referred to our local sleep clinic for examination.
Results: Classification performance was evaluated using accuracy,
sensitivity, specificity, and the Cohen's kappa coefficient against
PSG as ground truth, calculated for each individual and reported,
in order, as mean±std. The data set of young healthy sleepers was
split into training and testing sets, and our real-­time model achieved
results of [94.5 ± 2.7, 96.3 ± 3.1, 88.6 ± 8.6, 85.6 ± 7.4] for the night-
stand radar test set (n = 23) and [93.1 ± 3.4, 96.2 ± 3.7, 83.7 ± 12.3,
81.3 ± 10.6] for the ceiling radar test set (n = 21). The same model ap-
plied to a set of heterogenous sleep clinic patients (n = 26) achieved
results of [82.4 ± 13.9, 89.2 ± 17.0, 55.2 ± 15.9, 45.8 ± 24.5].
Conclusions: Our results indicate that while sleep/wake classifica-
tion is more difficult for heterogenous troubled sleepers, the radar
sensor has the potential to offer the benefits of real-­time contact-­
free actigraphic monitoring in hospital rooms.
Disclosure: This project is part of the Industrial PhD Scheme of
the Research Council of Norway and is thus jointly funded by the
Research Council and by Novelda AS, who develops the radar used
in this work. As a candidate in this Scheme the presenting author
(HSAH) is considered an employee both of Novelda AS and the
Norwegian University of Science and Technology (NTNU). Novelda
AS has provided hardware and office space for the presenting au-
thor, as well as the digital signal processing software used to ex-
tract body movement and respiration estimates from the raw radar
data. None of the other authors are affiliated with Novelda AS, and
Novelda AS has not participated in the decision to publish this data.
None of the other authors have any conflicts of interest to disclose.
P92 | The composition of physical activity,
sedentary behaviour and sleep duration across
24-­hours: associations with self-­rated sleep
quality in middle-­aged and elderly persons
A. Hofman1; T. Voortman1; A.I. Luik1,2
1
Epidemiology, Erasmus MC University Medical Center, Rotterdam;
2
Erasmus MC University Medical Center, Child and Adolescent
Psychiatry/Psychology, The Netherlands
Objectives/Introduction: Increasing physical activity and lowering
the amount of sedentary behaviour have previously been suggested
as modifiable behaviours to improve sleep quality. Yet, in previous
studies the co-­dependency between the duration of these activity
domains and sleep, being locked within the 24-­hour day, has often
not been taken into account. Therefore, we examined the associa-
tions of reallocations of time among daily movement behaviours and
sleep with self-­rated sleep quality in a population-­based sample of
middle-­aged and elderly persons.
Methods: Between 2011 and 2016, a total of 1,943 participants
(mean age 71 ± 9 years, 52% women) from the population-­based
Rotterdam Study were included. All participants wore a tri-­
axial
accelerometer (GeneActiv, ActivInsights, Cambridge, UK) on their
non-­dominant wrist (mean duration 5.9 days). Accelerometer data
were used to estimate the durations of sleep, sedentary behaviour,
light and moderate-­to-­vigorous physical activity. Participants ad-
ditionally completed the Pittsburgh Sleep Quality Index (PSQI) to
self-­rate sleep quality. Cross-­sectional associations were examined
using compositional isotemporal substitution analyses, adjusted for
ABSTRACTS
age, sex, living situation, education, employment, body mass index,
history of cancer, coronary heart disease, stroke and diabetes, psy-
choleptics and psychoanaleptics use, smoking, and alcohol use.
Results: A reallocation of 30 minutes more sleep was associated
with a −0.21 (95%CI: −0.27; −0.15, p < 0.001) points lower PSQI
score, indicating better sleep quality, when replacing sedentary
behaviour in the confounder adjusted model. This association was
similar in men (estimated difference −0.22, 95%CI: −0.29; −0.15,
p  <  0.001) and women (estimated difference −0.19, 95%CI: −0.29;
−0.09, p = 0.045). No other replacements between sleep, sedentary
behaviour, light and moderate-­to-­vigorous physical activity were as-
sociated with sleep quality in the confounder adjusted models.
Conclusions: Replacing sedentary behaviour with sleep is associated
with a better sleep quality, no other replacements were associated
with better sleep quality. This suggests that light and moderate to
vigorous physical activity are not related to self-­rated sleep qual-
ity when sleep duration is taken into account in this population of
middle-­aged and elderly. Although we cannot draw any conclusions
on the temporality from these associations, we speculate that tar-
geting sedentary behaviour might be particularly important for sleep
quality in this age group.
Disclosure: Nothing to disclose.
P93 | Impact of COVID-­19-­related lockdown on
self-­reported sleep characteristics in the Italian
population
O. De Rosa1; N. Cellini2,3,4; F. Conte1; S. Malloggi5; B.
Albinni1; M. Cerasuolo1; F. Giganti5; G. Ficca1
1
Department of Psychology, University of Campania -­Luigi Vanvitelli,
Caserta; 2Department of General Psychology; 3Department of
Biomedical Sciences; 4Padova Neuroscience Center, University of
Padova, Padova; 5Department Neurofarba, University of Florence,
Firenze, Italy
Objectives/Introduction: From March 8th to May 4th, 2020, most
residents of the Italian territory have been forced to home confine-
ment (‘lockdown’) in the attempt to contain the COVID-­19 epidemic.
The lockdown has substantially modified daily routines, including
working conditions, levels of physical activity and daylight exposure.
Here we aimed to investigate how these restrictions affected peo-
ple's self-­reported sleep characteristics.
Methods: A sample of 1622 participants aged 18 to 79 years (mean
age = 34.1 ± 13.6y; 1171 F) completed an online survey from April
1st to April 20th, 2020, advertised across the whole nation via so-
cial media (Facebook) and University websites. Participants had to
respond to a set of questionnaires, including the Pittsburgh Sleep
Quality Index, referring to their current situation and, retrospec-
tively, to their situation before the lockdown.
Results: Linear mixed-­
model analysis showed that, during lock-
down, people went to bed and woke up 48 min and 73 min later,
|
      115 of 356
respectively, than before lockdown (p  <  0.001 for both compari-
sons). Sleep quality significantly decreased in the general population
(p < 0.001), in particular in women (p = 0.026). Younger age and even-
ing preference were positively associated (covariates) with greater
sleep quality deterioration (p = 0.006 and p < 0.001, respectively).
The proportion of subjective bad sleepers (PSQI > 5) increased from
37.7% to 54.2% (p < 0.001). A logistic regression confirmed that the
risk of sleep issues was higher in women (OR = 1.74), young adults
(OR = 1.50), evening-­types (OR = 2.4) and unemployed subjects
(OR = 2.35).
Conclusions: Our data show that the COVID-­19-­related lockdown
has negatively affected sleep quality in a large Italian sample, with
gender, age, chronotypology and working status as factors modulat-
ing the risk of developing sleep disturbances. Considering the critical
role of sleep for mental and physical well-­being, these findings high-
light the need to more closely monitor sleep habits in the general
population and possibly develop preventive interventions for sleep
quality in at risk populations.
Disclosure: Nothing to disclose.
P94 | Associations between self-­reported
sleep duration and cardiometabolic risk factors in
young African-­origin adults from the five-­country
Modeling the Epidemiologic Transition Study
(METS)
D. Rae1; L. Dugas2; L. Roden3; E.V. Lambert1; P. Bovet4;
J. Plange-Rhule5; T. Forrester6; W. Riesen7; W. Korte7; S.
Crowley-Mcwilliam8; S. Reutrakul9; A. Luke2
1
University of Cape Town, Cape Town, South Africa; 2Loyola University,
Chicago, IL, United States; 3Coventry University, Coventry, United
Kingdom; 4University Centre for Primary Care and Public Health
(Unisaté), Lausanne, Switzerland; 5Kwame Nkrumah Universities of
Science and Technology, Kumasi, Ghana; 6University of the West
Indies, Kingston, Jamaica; 7Canton Hospital, St Gallen, Switzerland;
8
Rush University Medical Center, Chigaco; 9University of Illinois at
Chicago, Chicago, IL, United States
Objectives/Introduction: The objective of this study was to investi-
gate associations between self-­reported sleep duration and cardio-
metabolic (CM) risk factors in African-­origin adults residing in five
countries spanning the epidemiologic transition.
Methods: In this cross-­sectional study, men and women were re-
cruited from Ghana (n = 491), South Africa (n = 503), Jamaica
(n = 508), Seychelles (n = 501) and America (n = 480). Self-­reported
sleep duration was obtained using questionnaires. Sex-­and site-­
stratified logistic regression analyses investigated relationships be-
tween sleep duration, individual CM risk factors and a binary CM risk
variable (presence of ≥ 3 CM risk factors), adjusting for age, physical
activity and education.
 |
116 of 356       ABSTRACTS
Results: Sleep duration distributions varied by cohort: 44.5%,
41.4%, 35.9%, 16.8% and 2.5% of American, Jamaican, Seychellois,
Ghanaian and South African men reported < 7 h sleep per night re-
spectively (p < 0.001). Similarly, 42.6%, 28.6%, 25.2%, 12.8% and
1.5% of American, Jamaican, Seychellois, Ghanaian and South African
women reported < 7 h sleep respectively (p < 0.001). American men
reporting ≤ 6 h sleep were more likely to be in the elevated CM risk
group (OR: 2.52, 95%CI: 1.02, 6.22, p = 0.045) and to have a high
waist circumference (OR: 2.44, 95%CI: 1.07, 5.57, p = 0.034) com-
pared to those reporting 8 h sleep. Jamaican women reporting ≤ 6 h
sleep (OR: 2.53, 95%CI: 1.19, 5.36, p = 0.016) and American women
reporting 7 h sleep (OR: 2.71, 95%CI: 1.17, 6.26, p = 0.002) were
more likely to be obese than those reporting 8 h sleep.
Conclusions: Associations between short sleep and CM risk factors
were only evident in the American men and women and Jamaican
women. Future interventions to address CM risk and sleep health may
need to be country-­specific when targeting high-­risk populations.
Disclosure: Nothing to disclose.
P95 | Different but complementary roles
of NREM and REM sleep in facilitation of
visual perceptual learning associated with
neurotransmitters changes revealed by magnetic
resonance spectroscopy
M. Tamaki1,2; Z. Wang1; T. Barnes-Diana1; D. Guo1; E.G.
Walsh1; T. Watanabe1; Y. Sasaki1
1 2
Brown University, Providence, RI, United States; National Institute of
Occupational Safety and Health, Kawasaki, Japan
Objectives/Introduction: While sleep is known to be beneficial to
visual perceptual learning (VPL), the roles of NREM and REM sleep in
facilitating VPL remain unclear (Sasaki, Nanez and Watanabe, 2010).
It has been demonstrated that NREM sleep plays a role in perfor-
mance enhancement, while REM sleep makes VPL more resilient to
retrograde interference caused by training of a new and different
task (Tamaki, Berard, Watanabe and Sasaki, 2018). These results
suggest that plasticity of VPL increases for performance enhance-
ment during NREM sleep, while it decreases for stabilization during
REM sleep.
Methods: To test this hypothesis, for the first time using magnetic
resonance spectroscopy we measured the concentrations of ex-
citatory (glutamate) and inhibitory (GABA) neurotransmitters in the
early visual area (EVA), during NREM sleep and REM sleep (N = 10).
We previously found that the excitation (E)/inhibition (/I) ratio, the
ratio of the concentrations of glutamate to GABA in EVA, represents
the amount of plasticity of VPL. Thus, in the current experiment,
we measured E/I ratios during NREM and REM sleep between two
trainings on the texture discrimination tasks (TDT) with orthogonal
background elements. Successive trainings on these stimuli are
known to cause retrograde interference.
Results: The results replicated previous finding that performance on
TDT trained before sleep increased without retrograde interference
by new training after NREM and REM sleep. Importantly, the E/I
ratio significantly increased during NREM sleep while it decreased
during REM sleep. Furthermore, the E/I ratio during NREM sleep
was correlated with performance enhancement over sleep (r = 0.82,
p < 0.001, n = 10), while the lower the E/I ratio during REM sleep, the
more resilient to retrograde interference (r = −0.77, p = 0.025, n = 8).
Conclusions: These results show that NREM sleep increases plastic-
ity to enhance VPL, while REM sleep decreases plasticity to stabilize
once enhanced VPL during NREM sleep. In conclusion, NREM and
REM sleep play complementary roles for VPL, which are reflected by
significantly different neurochemical processing.
Disclosure: Nothing to disclose.
P96 | Hypocretinergic interactions with
the serotonergic system regulate REMS and
cataplexy
A. Seifinejad; S. Li; M.-L. Possovre; A. Vassalli; M. Tafti
University of Lausanne, Lausanne, Switzerland
Objectives/Introduction: Cataplexy is a major symptom of nar-
colepsy and is defined as a sudden loss of muscle tone during
wakefulness while consciousness is preserved. It is a dynamic,
multi-­phased process which involves different brain regions before,
during and after its occurrence. In narcolepsy patients night-­time
sleep is fragmented and sleep onset REM episodes prematurley
occur. Monoaminergic neuronal populations that are important
wake-­promoting systems play also an important role in the patho-
physiology of narcolepsy with cataplexy. In this work we sought to
understand if the modulation of the serotonergic transmission can
influence cataplexy occurrence in mice and carefully investigated
Hcrt knockout mice lacking serotonin transporter. We also analyzed
mice in which Hcrt projection to 5HT system was disrupted.
Methods: the mice were implanted with EEG electrodes and EMBLA™
3™
hardware was used for signal acquisition and Somnologica-­
(Medcare) software for data analysis. High resolution camera also
was used to record animal's behavior during different vigilance
states.
Results: Heterozygous mice for Hcrt gene (Hcrt+/ko) were crossed
with heterozygous 5HTT mice and wild type (WT), Hcrt null (HcrtKO/
KO
), 5HTT null (5HTTKO/KO), 5HTT+/KO;HcrtKO/KO, and Hcrt/5HTT dou-
ble knockout (DKO) littermates were analyzed. Additionally, using
AAV injection in the dorsal raphe of WT mice we disrupted LHHCRT
- DR5HT circuit. We show that deleting the 5HT transporter in hypo-
cretin knockout mice suppressed cataplexy while dramatically in-
creased REM sleep. Additionally, double knock out mice showed a
significant deficit in the buildup of sleep need. Deleting one allele of
ABSTRACTS
the 5HT transporter in hypocretin knockout mice strongly increased
the EEG theta power during REM sleep and theta and gamma pow-
ers during wakefulness. Deleting hypocretin receptors in the dorsal
raphe neurons of adult mice did not induce cataplexy but consoli-
dated REM sleep.
Conclusions: Our results indicate that cataplexy and REM sleep are
regulated by different mechanisms and both states and sleep need
are regulated by the hypocretinergic input into 5HT neurons.
Disclosure: Nothing to disclose.
P97 | Altitude-­induced sleep apnea is highly
dependent on the ethnic (Sherpa vs Tamang)
background
G. Heiniger; S. Walbaum; C. Sartori; A. Lovis; R. Heinzer
Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
Objectives/Introduction: High altitude-­induced hypocapnic alkalo-
sis generates central sleep apnea (CSA) in individuals with normal
nocturnal breathing at low altitude. CSA occurs at highly variable
altitude among individuals, which could be due to genetic variations
in breathing control. In Nepal, inhabitants can be of different ethnic
backgrounds: Sherpas ethnic group has been living at high altitude
for hundreds of generations whereas Tamang are originally from
lowlands. The aim of this study is therefore to compare CSA severity
at high altitude between these two ethnic groups.
Methods: Nocturnal breathing of 20 Sherpas were compared to 20
Tamangs (all males with same ethnic group for at least three genera-
tions, mean±SD age 26.8 ± 9.7 vs 30.3 ± 11.3 y.o., mean±SD BMI
23.9 ± 3.0 vs 24.6 ± 4.0 respectively). Polygraphic recordings with
airflow, oxygen saturation and heart rate, were performed in Nepal
at ‘low’ 2′020 m (L) and high 4′380 m (H) altitudes. Ventilation (VE:
L/min) and exhaled CO2 (PETCO2%) were measured at rest at the
same altitudes. Differences between A and H in apnea-­hypopnea
index (AHI), oxygen desaturation index (ODI) and % of nocturnal pe-
riodic breathing (NPB) were calculated.
Results: Compared to Tamangs, Sherpas showed a lower in-
crease in AHI (+12.1 ± 12.2/h vs + 44.2 ± 27.8/h, p < 0.0001), ODI
(+17.9 ± 14.3/h vs 46.7 ± 29.1/h, p < 0.004), and NPB (3.3 ± 6.9%
vs 20.4 ± 21.5%, p < 0.002). Compared to Tamangs, Sherpas’ VE at
rest was higher at L (8.7 ± 2.1 vs 6.6 ± 2.1 L/min, p < 0018) and H
(10.1 ± 2.1 vs 8.5 ± 2.2 L/min, p < 0,003). FETCO2 dropped more in
Tamangs (−0.8016 + /-­ 0.33% vs −0.504 + /-­ 0.44%, p < 0.023).
Conclusions: High altitude dwelling Sherpas showed a significantly
lower increase in sleep breathing disorders between L and H com-
pared to low altitude dwelling Tamangs. This suggests that there
could be genetic differences in breathing control, with altitude-­
adapted Sherpas showing a higher respiratory drive and a lower drop
in CO2 level at high altitude.
Disclosure: Nothing to disclose.
|
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P98 | The effect of insufficient sleep on
microglial morphology
S. Steffens; H.-K. Wigren; T. Stenberg
Sleep Well Research Group, University of Helsinki, Helsinki, Finland
Objectives/Introduction: Sleep deficiency is a common problem in
modern society.
Insufficient sleep leads to an immune response and many molecu-
lar immune mediators are crucially involved in sleep regulation. The
brain's main immune cells, microglia, take part in maintaining tissue
homeostasis in highly ramified steady-­state, and upon immune chal-
lenge they transform into a reactive state with increased soma size
and de-­ramification.
However, as little is known about the effects of insufficient sleep on
microglia, wherefore we investigated how they are affected by acute
sleep deprivation (SD) and chronic sleep fragmentation (SF).
Methods: Acute 9 h SD was performed with the gentle handling
method and the 14d chronic SF by housing the mice (C57BL/6JR)
in a Sleep Fragmentation Chamber (Lafayette), in which sleep is au-
tomatically interrupted in 2 min intervals during the 12 lights-­on
period.
After the treatments the animals were deeply anesthetized and
perfused, brain tissue was immunostained for microglia (anti-­IBA1,
Synaptic Systems) and imaged with a confocal microscope (TCS SPX,
Leica). Morphometric analyses of the 3-­dimensional microglia re-
constructions from the somatosensory cortex (SSC), the hippocam-
pus (HC) and the basal forebrain (BF) were accomplished using Fiji
(ImageJ, NIH).
Results: Preliminary results show that cortical microglia are affected
by both: acute and chronic sleep disruption (Ncells =20, p < 0.005,
Nmice=8) in a way that does not equal the classical response to im-
mune stimuli (Ncells =10, p < 0.005, Nmice=4). Microglia in the basal
forebrain and hippocampus are not affected by sleep disruption.
Conclusions: Cortical microglia are differently affected by insuffi-
cient sleep than microglia in basal forebrain and hippocampus.
Disclosure: Nothing to disclose.
P99 | Influence of CRHR1 genotype on sleep
and cortisol of healthy volunteers after Trier
Social Stress Test in the late evening
J. Weeger1; M. Ising1; B. Müller-Myhsok1; M. Uhr1; U.
Schmidt1,2,3; A. Yassouridis1; A. Steiger1
1
Max Planck Institute Planck Institute of Psychiatry, Munich;
2
Department of Psychiatry and Psychotherapy, University of Göttingen,
Göttingen; 3University of Bonn, Bonn, Germany
Objectives/Introduction: The Trier social stress test (TSST) is well
established to induce psychological stress in human experiments. So
 |
118 of 356       ABSTRACTS
far its effects on sleep is unknown. Variants in the single nucleotide
(SNP) rs110402 of the polymorphism of the corticotropin-­releasing
hormone receptor type 1 (CRHR1) gene increase in interaction with
childhood maltreatment the risk for depression which is higher in
homozygous CC carriers of this SNP, whereas it is reduced in TT car-
riers. We examined the effect of TSST in the late evening on sleep
and cortisol and whether this effect is influenced by genotype.
Methods: 52 male healthy volunteers, 20 to 30 years old, without
any history of childhood trauma or any other risk of psychiatric dis-
order, were selected for their CRHR1 genotype. According to rand-
omized schedule subjects underwent two sessions, separated by one
week. After one night of adaptation polysomnography (PSG, 23.00
to 07.00) was recorded in our sleep laboratory. Before PSG subjects
were either exposed to TSST from 22.30 to 22.40 or underwent a
control setting without stress. Mental stress before and after TSST
was assessed by visual analogue scale (VAS). Saliva for later analysis
of cortisol was collected four times between 20.00 and 22.55.
Results: The sample consisted of 33 TT and 21 TT carriers. Effects
of CRHR1 genotype were found for cortisol levels 15 min after TSST
(TT < CC, p = 0.02), for VAS before TSST
(TT > CC, p = 0.03), but not after TSST and for REM density dur-
ing first half of the night (TT < CC, p = 0.04). TSST prompted, inde-
pendently from genotype, some changes of sleep EEG. Sleep period
time (p = 0.001), REM time (p = 0.006) and sleep efficiency index
(p = 0.008) decreased after TSST, whereas N2-­latency (p = 0.004)
and wake % of time in bed (p = 0.007) increased.
Conclusions: Our data show that the effect of TSST on cortisol and
REM density in healthy subjects is influenced by their CRHR1 geno-
type despite they have no other risk for depression as early trauma.
This is in contrast to previous studies. Furthermore TSST impaired
sleep independently of genotype.
Disclosure: Nothing to disclose.
P100 | Plasma amyloid β42 and obstructive
sleep: pilot study
I. Madaeva; N. Semenova; N. Kurashova; L. Sholokhov; S.
Kolesnikov; L. Kolesnikova
Scientific Center for Family Health and Human Reproduction Problems,
Irkutsk, Russian Federation
Objectives/Introduction: It is known that slow-­wave sleep duration
is associated with intracellular aggregation of amyloid β42 (Aβ42)
peptide in the neocortex. Also, slow-­wave sleep time is decreased
in patients with obstructive sleep apnea (OSA). The aim of this re-
search is to assess the sleep fragmentation influence to Aβ42 plasma
levels before and after continuous positive airway pressure (CPAP)
therapy in patients with OSA.
Methods: 22 patients with OSAS (mean age -­52.5 ± 2.7 years) and
20 persons without OSA (mean age -­49.1 ± 8.2 years) were examined.
Inclusion criteria: age 45 to 60 years; a clinical diagnosis of moderate
and severe OSA. Exclusion criteria: previous treatment for OSA
with CPAP or surgery; history of motor vehicle accident related to
sleepiness within the past 12 months; presence of chronic medical
conditions; shift work. ‫ۥ‬Patients with OSA were being treated with
CPAP -­therapy for 3 months. Polysomnography was performed to
all participants with OSAS before and after CPAP and control group.
Blood plasma was used as a material to determine the Aβ42 level by
an immunoassay method. Statistical analysis was performed by non-
parametric tests with p < 0.05 as the level of significance.
Results: Sleep fragmentation, 1–2 time increasing of the non-­rapid
eye movement sleep stage, arousal index and decreasing of slow-­
wave sleep and rapid eye movement sleep time were found in
patients with OSA before CPAP as compared to control. After CPAP-­
therapy the decreasing of AHI, arousal index and increasing of sleep
efficiency, oxygen saturation, the time of slow-­wave sleep and rapid
eye movement sleep were found in patients. Aβ42 levels were sig-
nificant lower in group with OSA before CPAP-­therapy as compared
to control and group with OSA after CPAP-­therapy (p < 0.05). There
were no differences in Aβ42 levels between control and main group
after treatment.
Conclusions: The moderate and severe OSA is associated with a de-
crease of Aβ42 plasma level. CPAP-­therapy leads to increase of this
peptide in blood plasma.
Disclosure: The authors report no conflicts of interest.
P101 | IL-­33 and soluble ST2 receptor as
mediators of systemic inflammation in OSA
patients
A. Gabryelska; M. Sochal; A. Owczarek; P. Białasiewicz
Department of Sleep Medicine and Metabolic Disorders, Medical
University of Lodz, Lodz, Poland
Objectives/Introduction: Obstructive sleep apnea syndrome (OSA)
is a chronic condition characterized by recurrent pauses in breathing
during sleep. OSA is frequently associated with chronic low-­grade
systemic inflammation.
Interleukin 1 superfamily (IL-­1) is a group of 11 cytokines which play
a role in a wide range of immune processes. IL-­33, one of the most
recently discovered members of IL-­1 superfamily is an alarmin cy-
tokine promoting inflammatory responses. IL-­33 signaling pathway
begins with binding of the cytokine to the ST2 receptor. Action of IL-­
33 is limited by soluble ST2 (sST2) receptor freely present in blood.
Therefore, the aim of the study was to investigate IL-­33 and receptor
sST2 protein level in blood serum of OSA patients and to compare it
to healthy individuals.
Methods: The study included 40 individuals, who underwent poly-
somnography (PSG) examination and based on apnea-­
hypopnea
index (AHI) were divided into severe OSA group (n = 20; AHI30; 85%
male) and healthy control (n = 20; AHI < 5; 70% male). All participants
had their peripheral blood collected in the morning (6:00–7:00 am)
ABSTRACTS
after the PSG. IL-­33 and sST2 protein concentration measurements
were performed using ELISA.
Results: Groups were matched regarding sex (p = 0.296), age
(p = 0.29) and total sleep time (p = 0.279). OSA group compared
to control group had both higher level of IL-­
33 serum protein
(118.15 pg/mL, IQR: 76.97 -­140.41 vs. 40.23 pg/mL, IQR: 27.43
-­93.95) and sST2 serum protein (209.54 50.39 pg/mL vs. 159.07
49.04 pg/mL). IL-­33 correlated with disease severity measured by
AHI (p < 0.001; r = 597), arousal index (p = 0.014, r = 0.385) and BMI
(p = 0.005, r = 0.438), while sST2 protein level was only associated
with AHI (p < 0.001, r = 0.538). Further, correlation between IL-­33
and sST2 protein level was observed (p < 0.001, r = 0.577). Multiple
regression, using the forward stepwise method, revealed that IL-­33
protein level was significantly affected only by AHI (p < 0.001) (but
not sST2 level, BMI, arousal index). Obtained model explained 41.9%
of IL-­33 protein level variability.
Conclusions: Chronic inflammation in OSA patients may be medi-
ated by IL-­33, which is associated with elevation of soluble ST2 re-
ceptor and severity of the disorder.
Disclosure: The study was founded within the project ‘Operation-­
Integration!’ integrated program of the Medical University of Lodz
POWR.03.05.00-­
0 0-­
z065/17 cofounded by the European Union
within Priority Axis III: Higher education for the economy and de-
velopment of the Operational Program Knowledge Education
Development for 2014–2020.
P102 | Cluster analysis to identify clinically
significant obstructive sleep apnea phenotypes
M.G. Silveira1; G. Sampol2; P. Lloberes2
1
Respirology Department, Parc Sanitari Sant Joan de Déu, Sant Boi de
Llobregat; 2Sleep Unit, Hospital Universitario Vall d'Hebron, Barcelona,
Spain
Objectives/Introduction: Obstructive sleep apnea (OSA) is a com-
plex and heterogeneous disease associated with multiple comor-
bidities. The aim of our study was to identify clinically significant
phenotypes in a cohort of OSA patients.
Methods: We performed a cluster analysis in 1217 consecutive pa-
tients diagnosed with OSA through cardiorespiratory polygraphy
or polysomnography. We used polygraphic data, anthropometrics,
Epworth Sleepiness Scale (ESS), comorbidities, and medicine con-
sumption. For clustering, we used a partitioning around medoids
technique. For comparison between groups we used an ANOVA or
a Kruskal-­Wallis test for quantitative variables, and a chi-­square or
Fisher's exact test, for categorical variables.
Results: Mean age was 58.1 years (CI:57.3;58.8), 71.4% males,
2
mean body mass index (BMI) 30.7Kg/m (CI:30.4;31),mean apnea-­
hypopnea index (AHI) 32.4 (CI:31.1;33.7) and ESS 7.2 (CI:6.9;7.4).
We obtained 3 clusters:: -­‘Healthy middle aged men with moder-
ate OSA’ (n = 553): 88.6% men, mean age 51.1 (CI:50;52.1) years,
|
      119 of 356
with overweight (mean BMI 29.4Kg/m2, CI:29;29.8), AHI 27.8
(CI:26.1;29.5), low nighttime hypoxemia (cumulative time with SaO2
< 90%, (CT90%)) 9.7 (CI 8.5;10.9) with moderate prevalence of hy-
pertension (HBP; 20.4%) and dyslipidemia (27.7%).
-­‘Older men with severe OSA, cardiovascular risk factors (CVRF) and
disease’ (n = 359): 86.1% men, mean age 63.4 years (CI:62.2;64.5),
obese (mean BMI 32.7Kg/m2, CI:32.1;33.2), AHI 45.8 (CI:43;48.5),
moderate nighttime hypoxemia (CT90% 28.4, CI:25.4;31.5) and
a high prevalence of CVRF (HBP 73%, dyslipidemia 76.3%, type-­2
diabetes mellitus 48.5%) and of atrial fibrillation (9.7%) and ischemic
heart disease (18.4%).
‘Older women with moderate OSA, HBP, dyslipidemia and depres-
sion’ (n = 305): 77% women, mean age 64.5 years (CI:63.5;65.6),
obese (mean BMI 30.7Kg/m2, CI:30.1;31.3), AHI 25.2 (CI:23.3;27.1),
lower ESS and low nighttime hypoxemia (10.5, CI:8.5;12.5), with a
high prevalence of HPB (63.9%), dyslipidemia (63%) and depres-
sion (15.7%), with high consumption of antidepressant (55.1%),
anxiolytic (40%), hypnotic-­sedative drugs (11.1%), nonsteroidal anti-­
inflammatories (67.9%), and weak opioids (15.1%).
Conclusions: We identified 3 different clinical clusters among con-
secutive OSA patients with mainly moderate and severe disease.
More studies are needed to analyze the phenotypes′ behaviour in
the long-­term, regarding clinical outcomes, and to see if these clus-
ters can be identified in different cohorts.
Disclosure: Nothing to disclose.
P103 | Nocturnal arterial pulsation waveforms
of obstructive sleep apnea patients are
associated with increased number of lapses in
psychomotor vigilance task
S. Kainulainen1,2; B. Duce3,4; H. Korkalainen1,2; A. Leino1,2;
R. Huttunen1; L. Kalevo1,2; E.S. Arnardottir5,6; A. Kulkas1,7; S.
Myllymaa1,2; J. Töyräs1,2,8; T. Leppänen1,2
1
Department of Applied Physics, University of Eastern Finland;
2
Diagnostic Imaging Center, Kuopio University Hospital, Kuopio,
Finland; 3Sleep Disorders Centre, Princess Alexandra Hospital;
4
Institute for Health and Biomedical Innovation, Queensland University
of Technology, Brisbane, QLD, Australia; 5Department of Engineering,
Reykjavik University; 6Internal Medicine Services, Landspitali -­
University Hospital of Iceland, Reykjavik, Iceland; 7Department of
Clinical Neurophysiology, Seinäjoki Central Hospital, Seinäjoki, Finland;
8
The School of Information Technology and Electrical Engineering,
University of Queensland, Brisbane, QLD, Australia
Objectives/Introduction: Severe intermittent hypoxemia, quantified
by the duration, depth, and frequency of oxygen desaturations, is
associated with daytime sleepiness and poor psychomotor vigilance
in obstructive sleep apnea (OSA) patients [1,2]. Besides hypoxemia
severity, electrocardiogram-­
based heart rate changes have been
linked to cognitive decline [3]. As OSA induces abnormal heart rate
 |
120 of 356       ABSTRACTS
variability [4], we hypothesized that the information content of the
photoplethysmogram (PPG) signal could also be linked to objectively
measured deterioration of sustained attention. Thus, our aim was to
examine whether the frequency domain information and features of
nocturnal PPG of OSA patients can be linked to poor performance in
psychomotor vigilance task (PVT).
Methods: PPG signals from 567 OSA patients, extracted from Type
1 diagnostic polysomnography, and corresponding results of PVT
were examined. The frequency content of complete PPGs was de-
termined, and analyses were conducted separately for men (n = 327)
and women (n = 240). Patients were grouped to PVT performance-­
quartiles based on the number of lapses (reaction times ≥ 500 ms)
and within-­test variation in reaction times. The best (Q1) and worst-­
performing (Q4) quartiles were compared as PVT does not have
clinical thresholds for performance metrics.
Results: We found that the increase in arterial pulsation frequency
(APF) in both men and women was associated with a higher number
of lapses. Higher APF was also associated with higher within-­test
variation in men, but not in women. In the regression analysis of the
whole population, median APF (β=0.27, p = 0.01), female sex (β=1.29,
p < 0.01), older age (β=0.03, p  <  0.01), and subjective sleepiness
(β=0.07, p < 0.01) were significant predictors of belonging to lapses
Q4. Only female sex (β=0.75, p  <  0.01) and depression (β=0.91,
p < 0.02) were significant predictors of belonging to Q4 based on the
within-­test variation in reaction times.
Conclusions: Increased APF in PPG provides a possible PSG-­
indicator for deteriorated vigilance especially in male OSA patients.
This finding highlights the connection between cardiorespiratory
regulation, impaired vigilance, and OSA.
References:
[1] Kainulainen et al, J Clin Sleep Med, 2019;15(8):1135–1142.
[2] Kainulainen et al, Eur Respir J, 2020;55(4).
[3] Yamaguchi et al, Hypertens Res, 2015;38:564–9.
[4] Guilleminault et al, The Lancet, 1984;1:126.
Disclosure: During conduction of the present study, funding was
received from the Research Committee of the Kuopio University
Hospital Catchment Area for the State Research Funding (projects
5041767, 5041768, 5041776, 5041779, 5041782 and 5041780),
the Academy of Finland (Decision numbers 313697 and 323536),
Seinäjoki Central Hospital, the Competitive State Research Financing
of Expert Responsibility Area of Tampere University Hospital
(grants VTR3221 and VTR3228), Business Finland (decision num-
ber 5133/31/2018), Paulo Foundation, Päivikki & Sakari Sohlberg
Foundation, The Research Foundation of the Pulmonary Diseases,
Finnish Cultural Foundation, Tampere Tuberculosis Foundation, and
the Respiratory Foundation of Kuopio Region.
P104 | Transsphenoidal adenomectomy is
associated with the amelioration of obstructive
sleep apnea in patients with active acromegaly
I. Filchenko1,2; L. Korostovtseva3; M. Bochkarev3; Y.
Sviryaev1,3; U. Tsoi3; E. Grineva3
1
Laboratory of Comparative Neuroendocrinology and Somnology, I.
M. Sechenov Institute of Evolutionary Physiology and Biochemistry;
2
Department of Neurology, North-­Western State Medical University;
3
Almazov National Medical Research Center, St. Petersburg, Russian
Federation
Objectives/Introduction: Sleep-­disordered breathing (SDB) is fre-
quent in acromegaly and may contribute to high cardiovascular risk
in these patients. We investigated the associations between endo-
crine, sleep and cardiovascular parameters in patients with active
acromegaly as well as the effect of radical transsphenoidal adenom-
ectomy (TSA) on these parameters.
Methods: The study was conducted within the Governmental pro-
gram for the investigation of acromegaly biomarkers and included
62 patients with active acromegaly. The patients underwent the
assessment of endocrine status (GH and IGF-­1), sleep character-
istics (polysomnography and Epworth Sleepiness Scale (ESS)) and
cardiovascular parameters (arterial stiffness (pulse wave velocity,
augmentation index) and blood pressure (BP) measurement and
echocardiography) before and 1 year after TSA. None of the pa-
tients received continuous positive airway pressure treatment for
SDB throughout the observation.
We used linear regression modeling with adjustment for age and
gender to explore the associations between endocrine status, sleep
and cardiovascular parameters. We compared the values before and
after surgery using Wilcoxon test.
Results: Endocrine status was associated with obstructive apnea-­
hypopnea index (AHI; GH: β=0.267, p = 0.048; IGF-­
1: β=0.302,
p = 0.015), microarousal index (GH: β=0.345, p = 0.028) and sleep
efficiency (IGF-­1: β=0.330, p = 0.023). GH was associated with aug-
mentation index (β = −0.334, p = 0.036) and right ventricular anterior
wall thickness (RV-­AWT; β=0.708, p = 0.003), while there were no
associations of IGF-­1 with cardiovascular parameters.
We found the following associations between sleep and cardiovas-
cular parameters: augmentation index with nocturnal heart rate (HR;
β = −0.320, p = 0.037), peripheral diastolic BP with sleep efficiency
(β=0.363, p = 0.024), RV-­AWT with obstructive (β=0.652, p = 0.010)
and total (β=0.517, p = 0.023) AHI and microarousal index (β=0.702,
p = 0.001), left ventricle posterior wall thickness with obstructive
(β=0.441, p = 0.010) and total (β=0.373, p = 0.018) AHI and sleep
efficiency (β=0.360, p = 0.042).
TSA reduced GH (p < 0.001) and IGF-­1 (p < 0.001) levels accompa-
nied by the decrease of ESS (p = 0.042), obstructive AHI (p = 0.016),
microarousal index (p = 0.011), sleep efficiency (p = 0.044), noctur-
nal HR (p = 0.001) and diastolic BP (p = 0.011). Arterial stiffness and
echocardiographic parameters remained stable.
ABSTRACTS
Conclusions: TSA is related to the amelioration of obstructive sleep
apnea (OSA) in patients with acromegaly. Despite the associations
between cardiovascular and sleep parameters, only minor changes in
cardiovascular parameters after TSA were detected within one year
of observation.
Disclosure: Nothing to disclose.
P105 | CPAP adherence trajectories in
obstructive sleep apnea -­unsupervised clustering
using real-­life datasets
1,2 1,3 3 3
S. Bailly ; G. Bottaz-Bosson ; A. Hamon ; A. Samson ; R.
Tamisier1,2; J.L. Pépin1,2
1
INSERM U 1042 -­HP2 Laboratory; 2Grenoble Alpes University
Hospital, La Tronche; 3Jean Keutzman Laboratory, Saint Martin
d'Hères, France
Objectives/Introduction: Daily CPAP tele-­
monitoring generates
every night an avalanche of individual data from million patients on
long term home treatment. This might be used to adapt personalized
patient's management. The aim of the current study was to iden-
tify distinct clusters of CPAP adherence trajectories during the first
3-­months after CPAP initiation.
Methods: We used 3-­month daily CPAP telemonitoring adherence
and clinical phenotyping data from university hospital of Grenoble.
Unsupervised clustering methods based on ascending hierarchical
clustering was used to identify 3-­month CPAP adherence trajecto-
ries, based on dynamic time warping dissimilarity.
Results: From a dataset of 745 OSA patients, six distinct clusters
of CPAP adherence trajectories were identified. Three clusters cor-
responded to stable trajectories but with different levels of CPAP
adherence: 1) Cluster 1 (N = 302, 40%): stable CPAP adherence tra-
jectory with fluctuations between 4 and 6 hours/night, 2) Cluster 2
(N = 168, 23%): stable CPAP adherence trajectory with fluctuations
between 6 and 8 hours and 3) Cluster 3 (N = 42, 6%): Highest CPAP
adherence trajectory with stable adherence above 8 hours by night.
Three clusters were labeled as unstable clusters with 1) Cluster 4
(N = 53, 7%) high CPAP adherence in the first month after CPAP
initiation and then abrupt adherence decrease or a stopping treat-
ment, 2) Cluster 5 (N = 86, 11.5%): low adherence trajectory (less
than 4 hours by night) with progressive descending of CPAP adher-
ence and 3) Cluster 6 (N = 94, 13%): Non-­adherence starting in the
first days after CPAP initiation.
Conclusions: Using unsupervised clustering with dynamic time
warping allowed identifying distinct CPAP adherence trajectories in
the first 3-­months after CPAP initiation. This knowledge might guide
personalized intervention facilitating allocation of resources.
Disclosure: Nothing to disclose.
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P106 | Time of day and chronotype effects on
children's intellectual capacity
L. Pires1,2,3; D. Couto 4; H.M.F. Cruz5; C. Bettencourt1,2; J.A.
Leitão1,2; M.H.P. Azevedo6; D.R. Marques2,4; A.A. Gomes1,2
1
Faculty of Psychology and Educational Sciences, University
of Coimbra; 2CINEICC -­FCT R&D Unit: Centre for Research in
Neuropsychology and Cognitive Behavioural Intervention, Coimbra,
Portugal; 3Department of Psychology, School of Life Sciences,
University of Hull, Hull, United Kingdom; 4Department of Education
and Psychology, University of Aveiro, Aveiro; 5Interdisciplinary
Research Centre for Education and Development (CeiED), University
of Lusófona, Lisboa; 6Faculty of Medicine, University of Coimbra,
Coimbra, Portugal
Objectives/Introduction: IQ tests are extensively used in school set-
tings to evaluate children's specific cognitive deficits that may con-
tribute to low academic achievement. Some studies found that IQ
assessments’ results can vary according to testing time and chrono-
type. The present study aimed to probe potential chronotype X time
of day (ToD) interactive effects on children's IQ results.
Methods: Sixty-­eight 2nd, 3rd or 4th-­graders (33 girls; 7–10 years
old) were randomly assigned to one of four conditions resulting from
crossing chronotype (morning-­or evening-­t ypes, using the 20th and
80th percentiles from morningness/eveningness scale score of the
Children ChronoType Questionnaire -­CCTQ) and ToD (first or last
hours of the school day -­9:00 am or 4:00 pm). All four groups were
matched by age, gender, educational grade, and sleep problems re-
ported by parents. Selected participants exhibited no known lan-
guage disorders, learning difficulties, or behavioural disturbances.
Cognition was assessed through WISC-­
III battery that provides
three composite IQ scores (Verbal, Performance, and Full IQ) and
four Index scores (Verbal Comprehension, Perceptual Organization,
Freedom from Distractibility, and Processing Speed). Age-­
based
standardized scores for all thirteen subtests were also analysed.
Results: No effects of chronotype X ToD were found in IQ, Index
and subtests scores. Still, main effects of chronotype and ToD were
uncovered. Children assessed in the morning revealed higher ver-
bal IQ scores (p  =  0.033, ηp2 = .069) and a better performance on
verbal subtests, Similarities (p = 0.045, ηp2 = .061) and Information
(p = 0.053, ηp2 = .057). Morning-­t ypes showed higher scores in the
Perceptual Organization Index (p = 0.033, ηp2 = .069) and a better
performance on the Arithmetic subtest (p = 0.031, ηp2 = .071) than
evening-­t ypes.
Conclusions: Results suggest that ToD influences children's perfor-
mance on Verbal IQ's tasks, seeming better to assess these tasks
in the morning. Concerning chronotype, morning-­type children of
our sample seem to have a better ability to interpret and organ-
ize visually-­presented material. However, no differences between
morning-­and evening-­type children were found in most WISC-­III
scores, including IQ scores. Taken together, our results suggest that
 |
122 of 356       ABSTRACTS
ToD of assessment sessions might influence IQ verbal scores in pri-
mary school children. Replication studies are needed.
Disclosure: All authors confirm that there are no conflicts of in-
terest associated with this publication. This work was developed
under the larger research project [PTDC/PSI-­EDD/120003/2010]
funded by the Portuguese Foundation for Science and Technology
(FCT) and FEDER/COMPETE/QREN. The completion of this work is
currently supported by Project True Times, hosted at the FPCEUC
-­Research Grant PTDC/PSI-­
ESP/32581/2017|CENTRO-­01-­0145-­
FEDER-­
032581, funded by FEDER, PT2020, CENTRO2020, and
FCT.
P107 | Do specific types of sleep disturbances
represent risk factors for poorer health related
quality of life in inflammatory bowel disease? A
longitudinal cohort study
A. Scott; O. Flowers; G. Rowse
University of Sheffield, Sheffield, United Kingdom
Objectives/Introduction: Poor global sleep quality is commonly
reported in people with Inflammatory Bowel Disease (IBD), and is
linked to poorer Health Related Quality of Life (HRQoL). However,
understanding is currently limited by a lack of; (1) longitudinal re-
search disentangling the effect of sleep on HRQoL; and (2) research
investigating the impact of specific types of problems sleeping on
IBD related outcomes, particularly on HRQoL.
Methods: N = 409 participants with IBD were recruited to a longitu-
dinal study, completing measures at baseline (T1) and 4-­weeks later
at T2. Four specific sleep disturbances associated with IBD including
sleep apnoea, insomnia, restless-­legs, and nightmares were meas-
ured alongside depression, anxiety and stress, and HRQoL.
Results: After controlling for participant demographics, T1 depres-
sion, anxiety, stress, and T1 HRQoL, more severe symptom severity
of sleep apnoea and insomnia symptoms at T1 significantly predicted
poorer HRQoL at T2. However, the experience of restless-­legs and
nightmares at T1 did not predict HRQoL.
Conclusions: Symptoms synonymous with sleep apnoea and insom-
nia might represent modifiable environmental risk factors that pro-
vide independent contributions to HRQoL over time in those with
IBD. These findings suggest that interventions designed to improve
sleep apnoea and insomnia could confer benefits to HRQoL in those
with IBD. However, more longitudinal research is needed to under-
stand the contribution of sleep disturbances over the longer term,
as well as more randomised controlled trials testing the effect of im-
proving sleep on IBD related outcomes.
Disclosure: Nothing to disclose.
P108 | Sleep duration on the first night
following a traumatic event and subsequent
intrusive memories
K. Porcheret1; L. Iyadurai2; M.B. Bonsall3; G.M. Goodwin2;
S.A. Beer4; M. Darwent4; E.A. Holmes5,6
1
Norwegian Center for Violence and Traumatic Stress Studies,
University of Oslo, Oslo, Norway; 2Department of Psychiatry;
3
Department of Zoology, University of Oxford; 4Emergency
Department, Oxford University Hospitals NHS Foundation Trust,
Oxford, United Kingdom; 5Department of Psychology, Uppsala
University, Uppsala; 6Department of Clinical Neurosciences, Karolinska
Institute, Stockholm, Sweden
Objectives/Introduction: Sleep disruption is common in the weeks
and months following a traumatic event and has been associated
with the development of post-­
traumatic stress disorder (PTSD).
Moreover, sleep focused treatment in individuals with PTSD, im-
proves PTSD symptoms as well as sleep. Experimental findings
suggest sleep immediately after an analogue traumatic event may
impact initial stress reactions including frequency of intrusive
memories in people and freezing behaviour in rodents. The aim of
this study was to assess sleep in the first week immediately after a
real-­world traumatic event and the impact of concurrent and later
psychopathology.
Methods: Patients (n = 87) admitted to the emergency department
on the day of their traumatic event completed a one-­week sleep and
intrusive memories diary. Post-­traumatic stress reactions, anxiety
and depression were assessed at 1 week and 2 months.
Results: A mixture model showed a significant U-­shaped relation-
ship, where short and long sleep durations on the first night were
associated with more intrusive memories in the subsequent week:
1 hr, 6.9 hr and 12.5 hr sleep durations associated with 20.74, 8.80
and 26.78 intrusive memories respectively. The same relationship
was also found in the change in sleep duration as assessed by the
Pittsburgh Sleep Quality Index completed for the month prior to the
traumatic event. The frequency of intrusive memories in this first
week was also found to be three times higher (M = 28.20 vs 9.96) in
individuals who went on to meet Clinician-­Administered PTSD Scale
(CAPS) criteria at 2 months.
Conclusions: Monitoring intrusive memories and sleep in the first
week post-­trauma, using a simple diary, may help identify individuals
more vulnerable to later psychopathology.
Disclosure: KP and LI were funded by a Wellcome Trust Strategic
Award [098461/Z/12/Z] to the Sleep and Circadian Neuroscience
Institute (SCNi) at the University of Oxford. LI is on the British
Association for Behavioural and Cognitive Psychotherapies
Scientific Committee and via this role is funded to attend the Annual
Conference. LI conducts occasional teaching and clinical training
workshops, some of which include a personal fee. EAH receives
support from the Swedish Research Council (VR) 2017-­0 0957, the
Lupina Foundation, and the Oak Foundation (OCAY-­18-­4 42). EAH
ABSTRACTS
reports serving on the Board of MQ; transforming mental health,
on the Editorial Advisory Board of The Lancet Psychiatry, and as
Associate Editor of Behaviour Research and Therapy. EAH re-
ceives book royalties from Oxford University Press and Guildford
Press, and occasional personal fees from clinical workshops and
conference keynotes, outside the submitted work. GMG is a NIHR
Emeritus Senior Investigator. He holds shares in P1vital and has
served as consultant, advisor or CME speaker in the last 3 years for
Allergan, Angelini, Compass pathways, MSD, Lundbeck (/Otsuka or
/Takeda), Medscape, Minervra, P1Vital, Pfizer, Sage, Servier, Shire,
Sun Pharma. KP, MBB, SAB and MD declare no other conflicts of
interest. The views expressed are those of the author(s) and not nec-
essarily those of the NHS, the NIHR or the Department of Health.
P109 | Sleep characteristics in patients with
tramadol dependence
E. Abdullah1; F. Moussa1; M. Ezat1; M. Basheer2; A. Saleh1,3
1 2
Psychiatry; Clinical Neurophysiology, Faculty of Medicine Cairo
University; 3Cairo Center for Sleep Disorders, Cairo, Egypt
Objectives/Introduction: Although Tramadol is generally consid-
ered as a medicinal drug, it has the potential to cause dependence
especially when used for prolonged periods of time and with higher
doses. Tramadol abuse has lately become a serious health problem
in Egypt. Opioid drugs including tramadol have a profound effect on
sleep that is clinically recognized. However, limited research studies
have investigated the impact of tramadol dependence on sleep.
1. To compare sleep architecture of patients with Tramadol depend-
ence to matched controls.
2. To determine the factors related to Tramadol abuse that might be
associated with changes in sleep architecture.
Methods: The study was a case control, comparative, study done on a
convenient sample of Egyptian patients with Tramadol dependence.
The patient group comprised 40 patients fulfilling the Diagnostic and
Statistical Manual of Mental Disorders (DSM-­IV-­TR) criteria for tram-
adol dependence that were recruited from Psychiatry and Addiction
Medicine Hospital, Cairo University inpatient addiction ward, that
were compared to 20 matched controls. Subjects were subjected to
Addiction Severity Index (ASI), Sleep Disorder Questionnaire (SDQ),
and underwent an overnight attended polysomnographic study in
the sleep lab of the hospital on the first night of admission before
detoxification protocol was applied.
Results: Patients showed increased sleep latency (p = 0.000), re-
duced total sleep time (p = 0.013) and sleep efficiency (p = 0.000),
increased arousal index (p = 0.000), reduced percentage of both
slow wave sleep (SWS) (p = 0.004) and REM sleep (p = 0.018) when
compared to control subjects. The average daily dose of Tramadol
used among patients had a highly statistically significant negative
correlation with the total sleep time (r = −0.638, p = 0.000) and sleep
|
      123 of 356
efficiency (r = −0.621, p = 0.000) and a highly statistically significant
positive correlation with sleep latency (r = 0.539, p = 0.000).
Conclusions: Patients with tramadol dependence show disturbed
sleep pattern in the form of reduced sleep efficiency and frequent
arousal from sleep in addition to reduced SWS and REM sleep. These
disturbances were related to higher doses of Tramadol use.
Disclosure: Nothing to disclose.
P110 | Dissociative symptoms in narcolepsy
L. Quaedackers1,2; H. Droogleever Fortuyn3; M.
Lappenschaar4; M. Van Gilst1,5; S. Overeem1,5
1
Center for Sleep Medicine, Kempenhaeghe, Heeze; 2Department of
Industrial Design, Eindhoven University of Technology, Eindhoven;
3
Department of Psychiatry, Radboud University Medical Center;
4
Institute for Computing and Information Science, Radboud University,
Nijmegen; 5Department of Electrical Engineering, Eindhoven University
of Technology, Eindhoven, The Netherlands
Objectives/Introduction: The core symptoms of narcolepsy, most
notably cataplexy and excessive daytime sleepiness, are well known.
However, there is mounting evidence for a much broader symptom
spectrum, including psychiatric symptoms. Disordered sleep has
previously been linked with dissociative symptoms, which may imply
that patients with narcolepsy are more prone to develop dissocia-
tive symptoms. With this study we aim to investigate the frequency
of dissociative symptoms and disorders in patients with narcolepsy
type 1 compared to healthy control subjects.
Methods: Sixty patients diagnosed with narcolepsy type 1 and
120 matched healthy control subjects were interviewed using the
Schedules for Clinical Assessment in Neuropsychiatry (SCAN) to as-
sess dissociative symptoms and disorders.
Results: Significantly more patients fulfilled the DSM-­IV criteria of a
dissociative disorder compared to healthy controls (62% versus 1%
respectively, p < 0.001). More than half of the patients
(53% versus 0% in controls, p < 0.001) met the criteria of a ‘dissocia-
tive disorder not otherwise specified’ and 8% for ‘dissociative am-
nesia disorder’ (versus 0% in controls, p = 0.004). Most frequently
reported dissociative symptoms by patients were ‘dissociative
amnesia’
(37% compared to 1%, p < 0.001) and ‘dissociative disorder of vol-
untary movement’ (32% versus 1%, p < 0.001). None of the controls
reported having experienced derealization and only one of the con-
trols experienced depersonalization, compared to respectively nine
(derealization people,
15% versus 0%, p  <  0.001), eight (derealization things, 13% ver-
sus 0%, p  <  0.001) and eight (depersonalization, 13% versus 1%,
p = 0.001) in narcolepsy patients.
Conclusions: Dissociative symptoms and disorders are strikingly
prevalent in patients with narcolepsy type 1. The reasons for this
remain unknown as of yet. In part, there may be symptom overlap
124 of 356      |
between narcolepsy and dissociation. However, there may also be
a more direct link between disrupted sleep and dissociative symp-
toms. In either case, the high frequency of occurrence of dissocia-
tive symptoms should result in more active inquiry by doctors, to
improve therapeutic management and guidance for people with
narcolepsy.
Disclosure: Nothing to disclose.
P111 | Infant habitual sleep and its relation to
sustained and orienting attention in the first year
of life: a longitudinal eye-­tracking and actigraphy
study
L.K. Gossé1; L. Mason1; F. Wiesemann2; C. Elwell3; E. Jones1
1 polysomnographic study
Centre for Brain & Cognitive Development, Birkbeck, University of
London, London, United Kingdom; 2Research & Development, Procter
& Gamble, Schwalbach am Taunus, Germany; 3Department of Medical
Physics and Biomedical Engineering, Biomedical Optics Research
Laboratory, University College London, London, United Kingdom
Objectives/Introduction: Research has shown that sleep facilitates
healthy development. Attention is crucial to development as it de-
termines what an infant perceives and learns. E.g. poor attention
(especially target disengagement) may be indicative of delayed de-
velopment (Kulke, 2015). When studying pre-­verbal infants devel-
opmental sciences rely on parent-­report measures to assess sleep
and/or attention, but parent-­report is subject to many biases (Sadeh,
1996). Therefore, objective measures like actigraphy, to assess sleep
patterns, and eye-­tracking, to assess attention, are needed. For this
poster we used objective and subjective methods to track the rela-
tionship of sleep and sustained and orienting attention in the first
year of life.
Methods: A longitudinal study (up to 4 study visits/participant) ex-
ploring the relationship between sleep and early neurocognitive
development was conducted. N = 76 (166 study visits) typically de-
veloping infants were studied (age: 4–14 months). Sleep measures
were the Brief Infant Sleep Questionnaire (Sadeh, 2004) and a 7-­day
sleep diary and actigraphy (w-­GT3X-­BT, ActiGraph).
The following eye-­tracking (Tobii-­X120) tasks were used as objective
measure of attention: gap-­overlap task (Elsabbagh, 2009) to study
orienting, face-­
pop-­
out task (Wass, 2015) and habituation task
(Powell, 2016) to study sustained attention. To investigate individual
differences, sleep patterns of good and poor sleepers and their re-
lation to attentional control, correlational, mixed model and cluster
analyses are performed.
Results: Correlational analyses showed no evidence of an effect of
habitual sleep duration and fragmentation on average disengage-
ment speed as measured by the gap-­overlap-­task. Further, longer
night sleep period was associated with a more consistent perfor-
mance in target disengagement (r = -­.294, p < 0.01). Data indicate
a developmental shift between 10 and 12 months of age in this
ABSTRACTS
relationship. Relations of clusters of poor and good sleepers to at-
tentional control and attempted replication of the above finding in
the habituation and pop-­out-­t ask are presented.
Conclusions: Initial results hint towards the importance of studying
variability measures rather than averages in developmental sleep
science and studying objective measures of sleep and attention.
Moreover, clustering algorithms may be used to identify good and
poor sleepers to investigate the relationship between sleep and at-
tentional control from a novel angle.
Disclosure: This project received funding from the European Union′s
HORIZON 2020 Research and Innovation Programme under the
Marie Sklodowska-­Curie Grant Agreement No 721895.
P112 | Sleep of gifted children: a
M. Thieux1,2; A. Guignard-Perret2; A. Guyon1,2; S. Mazza3;
M. Zhang1; O. Revol4; S. Plancoulaine5; P. Franco1,2
1
Integrated Physiology of the Brain Arousal (WAKING Team), Lyon
Neuroscience Research Center; 2Pediatric Sleep Unit, Department
of Pediatric Clinical Epileptology, Sleep Disorders and Functional
Neurology, Hospices Civils de Lyon; 3Health Services and Performance
Research (HESPER); 4Developmental Psychology, Hospices Civils de
Lyon, Lyon; 5CRESS, INSERM, INRAE, Paris University, Paris, France
Objectives/Introduction: To compare the sleep structure of children
with high potential (HP) with those of control children. A second-
ary objective was to determine whether their cognitive profiles (ho-
mogeneous IQ vs heterogeneous IQ) leads to mood or behavioral
disturbances. The heterogeneity of the IQ is defined by an absolute
difference between verbal and performance indices higher than 15,
measured by the Wechsler Intelligence Scale for Children IV.
Methods: Thirty-­
three children with HP (64% of boys, median
10 years old) and 25 controls (64% of boys, median 11 years old) un-
derwent a one-­night polysomnography, an evaluation of intelligence
quotient (IQ), and filled standardized questionnaires of insomnia
(Insomnia Severity Index), sleepiness (Epworth Sleepiness Scale), de-
pressive feelings (Children Depression Inventory), anxiety (Hospital
Anxiety and Depression Scale), and attention disorders (Revised
Conners Parent Rating Scale). Non-­parametric tests (Fisher's exact
and Wilcoxon test) were used to compare characteristics between
these groups. HP is defined by an IQ ≥ 130.
Results: Children with HP had more heterogeneous IQ (p = 0.02), in-
somnia (p = 0.01), hyperactivity (p = 0.03), conducts (p = 0.03) and
learning (p = 0.04) complaints than controls. They also had more
REM sleep (p < 0.01) and less stage 1 sleep (p < 0.03) (in minutes and
proportion of total sleep time). Children with HP with a heterogene-
ous IQ had more clinical complaints (p = 0.002), anxiety (p = 0.02),
and somatization (p = 0.04) than children with HP with a homoge-
neous IQ. There was no difference between HP groups concerning
sleep characteristics.
ABSTRACTS
Conclusions: The sleep structure varied between children with HP
and controls: first ones had more REM sleep and less stage 1 sleep.
This higher amount of REM sleep might be advantageous for learn-
ing and might partially explain their gift. A heterogeneous IQ might
increase the risk for mood and behavioral disorders.
Disclosure: Nothing to disclose.
P113 | Processing of musical rhythms is
partially preserved in REM but not NREM sleep
R. Sifuentes-Ortega1; T. Lenc2; S. Nozaradan2; P. Peigneux1
1
UR2NF, Neuropsychology and Functional Neuroimaging Research Unit
at CRCN -­Center for Research in Cognition and Neurosciences and UNI
-­ULB Neurosciences Institute, Université Libre de Bruxelles; 2Institute
of Neuroscience (IONS), Université Catholique de Louvain, Brussels,
Belgium
Objectives/Introduction: Auditory processing is preserved during
sleep but the extent to which this capacity encompasses high-­level
perceptual processing remains debated. To address this question, we
recorded the EEG in response to musical rhythms during wakefulness
and sleep. In wakefulness, perception of periodicities is fundamental
for the emergence of high-­order representations such as the pulse-­
like meter perceived while listening to musical rhythm. Increasing ev-
idence has shown that EEG frequency-­t agged responses are elicited
at envelope frequencies of musical rhythms. Importantly, responses
at the perceived meter frequency are enhanced compared to enve-
lope meter-­unrelated frequencies, even in irregular rhythms where
meter frequencies are not supported by prominent acoustic cues.
Selective enhancement of these behaviorally-­relevant frequencies
thus provides an objective measure of high-­level perceptual auditory
processing that was compared here across sleep states.
Methods: Regular and irregular rhythms were played through
electromagnetically shielded earphones (ER2 Etymotic) to 14 par-
ticipants during consolidated night sleep stages N2, N3, REM and
post-­sleep wakefulness. Stimulation was interrupted at PSG-­signs
of arousal. EEG (ActiveTwo Biosemi) was recorded at 8192 Hz on
Cz, FCz, Fz, C3, and C4 derivations. Amplitudes of meter-­related and
meter-­unrelated frequencies were compared across states where
frequency-­t agged responses were identified.
Results: Frequency-­tagged responses were found at envelope fre-
quencies during wakefulness and REM sleep for both regular and
irregular rhythms (one-­sample t-­tests, ps  <  0.01), but not N2 and
N3 sleep (ps  >  0.21). Repeated-­measures ANOVA comparing the
amplitudes across State (wake vs. REM), Frequency (meter-­related
vs. meter-­
unrelated) and Rhythm (regular vs. irregular) revealed
only main effects of State (wake > REM, p = 0.001) and Frequency
(meter-­related > meter-­unrelated frequencies, p = 0.001). However,
finer-­
grained investigation of meter-­
related frequencies showed
that responses to higher-­order metrical grouping of the intervals
(1.25 Hz) were absent during REM only in the irregular rhythm in
|
      125 of 356
which those meter frequencies are not supported by prominent
acoustic input cues.
Conclusions: Frequency-­tagged responses to musical rhythm are
present during wake, and to a lesser extent in REM sleep, but only
for regular rhythms, and were not found in NREM sleep. Our results
show preserved capacity to respond to acoustic features of rhythms
but reduced capacity to endogenously generate meter representa-
tions during sleep.
Disclosure: Nothing to disclose.
P114 | A novel, time-­controlled, caffeine-­
release formula attenuates behavioural,
cognitive, emotional, and physiological signs of
sleep inertia
D. Dornbierer1; F. Yerlikaya2; R. Wespi1; M. Boxler1; C.
Voegel1; D. Baur1; M. Baumgartner1; T. Kraemer1; H.-P.
Landolt1
1
University of Zurich, Zurich, Switzerland; 2University of Ankara,
Ankara, Turkey
Objectives/Introduction: Sleep inertia is a state of reduced drive fol-
lowing awakening, dominated by feelings of grogginess and impaired
vigilance. Nutritional sources of caffeine, a potent adenosine recep-
tor antagonist, are widely used to reduce sleep inertia symptoms.
Nevertheless, the initial, most severe period of sleep inertia cannot
be alleviated by post-­awakening caffeine consumption. Given the
difficulties in effectively counteracting sleep inertia symptoms, we
aimed at developing a time-­controlled, caffeine-­release formula that
starts liberating caffeine with a delay of several hours, targeting an
efficacious dose of the stimulant briefly before planned awakening.
Methods: We comprehensively tested this innovative caffeine-­
release formula in healthy volunteers in two placebo-­controlled,
double-­blind, cross-­over studies. First, we established the in vivo caf-
feine release profile in 10 young men. Subsequently, we investigated
the formulas’ ability to improve behavioral, cognitive, emotional, and
physiological sleep inertia symptoms in 22 sleep-­restricted male vol-
unteers. Following oral administration of the engineered caffeine
(160 mg) release formula at 22:30, we kept the study participants
awake until 03:00, to increase sleep inertia symptoms upon awaken-
ing at 7:00 am from a shortened, 4-­hour sleep episode. Immediately
after awakening, we quantified with amply validated questionnaires
and behavioral tasks subjective state, psychomotor vigilance, and
cognitive performance, as well as followed the evolution of the corti-
sol awakening response. Sleep across the night and during a nap op-
portunity starting at 08:00 am was polysomnographically recorded.
The statistical analyses included independent linear mixed-­effects
models followed by Benjamini-­Hochberg corrected post-­hoc testing.
Results: Compared to placebo, the engineered caffeine formula im-
proved subjective sleep inertia ratings (p < 0.001), increased positive
and reduced negative affect scores (p < 0.001), accelerated median
 |
126 of 356       ABSTRACTS
reaction time on the psychomotor vigilance task (p < 0.001), pro-
longed the cortisol awakening response (p < 0.05), and attenuated
sleep tendency 1 hour after scheduled awakening (p < 0.05).
Conclusions: We conclude that time-­controlled caffeine administra-
tion shortly before awakening facilitates the sleep-­to-­wake transi-
tion in sleep restricted healthy men. Given the observed pro-­vigilant,
pro-­hedonic and cortisol secretagogue properties, clinical testing is
warranted to evaluate whether patients suffering from disabling
sleep inertia such as observed in various neuropsychiatric disorders
may benefit from this innovative pharmacological approach.
Disclosure: Dario Dornbierer and Firat Yerlikaya developed and pat-
ented this time-­controlled, caffeine-­release formula as potential nu-
traceutical sleep inertia countermeasure.
P115 | Effect of COVID-­19 lockdown on sleep
in young children: preliminary results from an
international online survey
A. Markovic1,2; C. Mühlematter1; M. Beaugrand1; O. Minot1;
D. Castiglioni1; V. Horii1; M. Berrozpe3,4; S. Kurth1,2
1
Department of Psychology, University of Fribourg, Fribourg;
2
Department of Pulmonology, University Hospital Zurich, Zurich,
Switzerland; 3Departamento de Psicología, Universidad Nacional de
4
Educación a Distancia (UNED); Centro de Estudios del Sueño Infantil
(CESI), Madrid, Spain
Objectives/Introduction: The coronavirus (COVID-­19) outbreak has
led many countries to introduce drastic lockdown measures. This ex-
traordinary situation altered daily routines of families. We examined
whether the lockdown affected sleep of young children.
Methods: An online survey was distributed internationally in five
languages during the lockdown (April-­May 2020). Sleep of children
younger than 3y (Brief-­Infant-­Sleep-­Questionnaire), demographics,
lockdown situation (e.g., cancelled childcare, working from home)
and stress level of caregivers were assessed. Answers from 469
primary caregivers (mean age of child = 1.5 ± 0.8y) were included.
The questions were answered with regards to the situation during
and before (retrospectively) the lockdown. The change in sleep was
quantified as difference between ‘before’ and ‘during’ in number of
nocturnal awakenings, sleep latency and sleep duration (two-­t ailed
paired t-­tests). Linear models were applied to quantify the effect of
quarantine, change in childcare/working arrangements/social inter-
action/level of isolation, caregiver's stress level/fear of infection,
children's siblings/age/gender, and pets. The best fitting model was
found by means of backward selection based on the Akaike informa-
tion criterion (AIC).
Results: All examined children's sleep variables significantly changed
from ‘before’ to ‘during’ the lockdown, including increased nocturnal
awakenings (p = 0.03) and sleep latency (p < 0.0001), and decreased
sleep duration (p = 0.001). Backward selection revealed an effect
of caregiver's stress level on children's sleep: increased stress was
associated with more awakenings (p = 0.0003), longer sleep latency
(p = 0.003) and shorter sleep duration (p = 0.004). Children from
caregivers in quarantine demonstrated a larger increase in number
of awakenings (p = 0.003). However, increased caregiver's stress was
also associated with quarantine status (p = 0.04) indicating a possibly
mediating role of stress.
Conclusions: The COVID-­19 lockdown resulted in decreased behav-
ioral sleep quality of young children, which was significantly linked
to caregiver's stress level. Subjective and retrospective caregiver
reports may be intertwined with caregiver's stress level. Follow-­up
data may shed light on the direction of the relationship as well as
contribute to the discovery of protective factors.
Disclosure: Nothing to disclose.
P116 | Self-­reported reasons for reduced
alertness among commercial airline pilots
M. Sallinen1,2; S. Puttonen1; K. Ketola3; A. Tuori3; J.
Virkkala1; T. Åkerstedt4,5
1
Finnish Institute of Occupational Health, Helsinki; 2Department
of Psychology, University of Jyväskylä, Jyväskylä; 3Finnair,
Helsinki, Finland; 4Stress Research Institute, Stockholm University;
5
Department of Clinical Neuroscience, Karolinska Institute, Stockholm,
Sweden
Objectives/Introduction: Many models and modelling tools of alert-
ness use the circadian and homeostatic processes as their main de-
terminants. However, little is known about the work-­related factors
shift workers themselves perceive decisive for their alertness. This
study examined the question among commercial airline pilots.
Methods: Twenty-­nine long-­haul (mean age 45 yr), 28 short-­haul
(40 yr), and 29 mixed fleet (41 yr) male pilots completed two-­month
field measurements resulting in 383, 701, and 532 shifts (flight
duty periods), respectively. If a pilot had felt himself sleepy during
a shift, he reported reason(s) for that in the end of the shift using a
select menu. The options were inadequate sleep, shift timing, a long
time without a break, conditions in the cockpit, poor visibility, other
flight arrangements, and other work-­related factors. On-­duty alert-
ness was measured by the Karolinska Sleepiness Scale (KSS). The
method of generalized estimating equation was applied in statistical
analyses.
Results: The options of inadequate sleep and shift timing were re-
ported in 42% and 44% of all 1616 shifts, respectively. The corre-
sponding proportions of the other options varied between 2% and
14%. The options of inadequate sleep and shift timing co-­occurred
with each other in 25% of all shifts. The proportion of shifts with the
option of inadequate sleep varied by shift type (p > 0.0001), peaking
during early morning shifts (80%). The proportion of shifts with the
option of shift timing also varied by shift type (p > 0.0001), peaking
during night shifts (92%). 63% of the night shifts and 49% of the
early morning shifts included KSS-­ratings (≥7) indicative of reduced
ABSTRACTS
alertness, whereas only 7%–13% of the other shift types showed
the same.
Conclusions: Inadequate sleep and shift timing are the most fre-
quently self-­reported reasons for reduced alertness among commer-
cial airline pilots who work irregular hours. These reasons frequently
co-­occur with each other and are especially reported during the
most soporific shifts. The results support the notion that the role
of the work-­related factors other than those exerting their effects
through the circadian and homeostatic processes plays a limited role
in reduced on-­duty alertness in shift work. However, differences
may exist among occupations.
Disclosure: Nothing to disclose.
P117 | Impact of social jetlag and chronotype
among non-­standard fixed schedules
S. Gamboa Madeira1; C. Santos Moreira2; T. Paiva3; T.
Roenneberg4
1
ISAMB; 2Medicine Clinic I, Faculty of Medicine, University of Lisbon;
3
CENC -­Sleep Medicine Center, Lisbon, Portugal; 4Medical Psychology,
Ludwing-­Maximilians University Munich, Munich, Germany
Objectives/Introduction: Shift work has been associated with an in-
creased risk of multiple diseases. The mechanisms involved include
shortened sleep duration but also circadian disruption.
Social Jetlag (SJL) has been proposed as a proxy for circadian mis-
alignment, resulting from the difference between the individual
chronotype and the working schedule. SJL has been increasingly
used in epidemiological research, however the impact of both
SJL and Chronotype among non-­standard fixed schedules is lack-
ing. Therefore, our aim is to investigate the impact of both SJL and
Chronotype according to the working schedule.
Methods: Blue-­collar workers (n = 350) performing non-­standard
schedules: early morning (6 am-­3 pm), late evening (3 pm -­12 pm)
and night work answered the Munich ChronoType Questionnaire.
Cardiovascular risk assessment was estimated thru European
SCORE system combining major risk factors: smoking, blood pres-
sure and cholesterol.
Results: Sleep Duration on Workdays (SDWork) was longer among
evening workers (7.1 ± 1.5 h), being morning workers the ones with
lower sleep duration (5.9 ± 1.2 h; p < 0.001). In terms of circadian mis-
alignment, SJL was lower among evening workers (1.1 ± 1.0 h), being
the night workers the ones with highest (x =
̃ 3.8 ± 2.9 h; p < 0.001).
Chronotype was significantly different among schedules, being the
morning workers the earliest (3.1 ± 1.2 h) (p < 0.001). Within morn-
ing workers, we observed a negative correlation between SDWork
and SJL (r = -­.226; p = 0.005), whereas among evening workers this
was not found (r = -­.072; p = 0.430). We found a negative correlation
(r = -­.439; p < 0.001) for the relationship between chronotype and
SDwork among morning workers, while in evening workers a posi-
tive correlation was found (r = -­.310; p = 0.003).
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Among all workers, the ones with a SDwork ≤ 6 h presented a higher
risk for having a deleterious cardiovascular profile (OR  =  2.3 [1.2–
4.3] (p = 0.009). This finding was only significant among early work-
ers (OR = 2.9 [1.2–7.1], p = 0.017).
Conclusions: The impact of both Chronotype and SJL vary deeply
with the working schedule. Fixed schedules pose a unique oppor-
tunity to adjust work to the individual chronobiology and possibly
mitigate the deleterious health consequences of shift work.
Disclosure: FCT Scholarship PDE/BDE/127787/2016.
P118 | A new set of composite, non-­redundant
electroencephalogram measures of non-­rapid eye
movement sleep based on the power law scaling
of the Fourier spectrum
R. Bódizs1,2; O. Szalárdy1,3; C. Horváth1; P. Ujma1,2; F.
Gombos4,5; P. Simor1,6,7; A. Pótári5,8; M. Zeising9,10; A.
Steiger9; M. Dresler11
1
Semmelweis University/Institute of Behavioural Sciences; 2National
Institute of Clinical Neurosciences; 3Institute of Cognitive Neuroscience
and Psychology; 4Department of General Psychology, Pázmány Péter
Catholic University; 5MTA‐PPKE Adolescent Development Research
Group; 6Eötvös Loránd University/Institute of Psychology, Budapest,
Hungary; 7Université Libre de Bruxelles (ULB), Bruxelles, Belgium;
8
Budapest University of Technology and Economics/Doctoral School
of Psychology (Cognitive Science), Budapest, Hungary; 9Max Planck
10
Institute of Psychiatry, Munich; Centre of Mental Health, Klinikum
11
Ingolstadt, Ingolstadt, Germany; Radboud University Medical Center/
Donders Institute for Brain, Cognition and Behaviour, Nijmegen, The
Netherlands
Objectives/Introduction: Features of sleep were shown to reflect
aging, typical sex differences and cognitive abilities of humans.
However, these measures are characterized by redundancy and ar-
bitrariness. Our present approach relies on the assumptions that the
spontaneous human brain activity as reflected by the scalp-­derived
electroencephalogram (EEG) during non-­rapid eye movement sleep
(NREM) is characterized by coloured noise-­like properties and is
based on the power law scaling of the Fourier spectra with the addi-
tional consideration of the oscillatory waves at specific frequencies,
termed sleep spindles.
Methods: Our polysomnography dataset contained 175 records (81
females, age range 17–60 years) and IQ scores were available for
149 participants (68 females). Power spectral densities were calcu-
lated for the NREM (N2 and N3) sleep EEG at 17 locations by relying
on 4 s Hanning-­t apered, non-­artefactual windows (mixed-­radix Fast
Fourier Transformation). Measures derived are the spectral intercept
and slope, as well as the maximal whitened spectral peak amplitude
and frequency in the sleep spindle range.
Results: As predicted, aging is associated with decreased overall
spectral slopes (p < 0.001) and whitened spectral peak amplitudes
 |
128 of 356       ABSTRACTS
in the spindle frequency range of frontoparietal recording locations
(p < 0.03). In addition, age associates with decreased sleep spindle
spectral peak frequencies in the frontal region (p < 0.01). Women
were characterized by higher spectral intercepts (p < 0.04) and
higher spectral peak frequencies in the sleep spindle range, except
the temporal locations (p < 0.04). No sex differences in whitened
spectral peak amplitudes of the sleep spindle range were found
(p > 0.054). Intelligence correlated positively with whitened spectral
peak amplitudes of the spindle frequency range in women at centro-
parietal recording locations (p < 0.03), but not in men (p > 0.42). Last,
age-­related increases in spectral exponents did not differ in subjects
with average and high intelligence (p > 0.37).
Conclusions: Our parameters effectively reduce 191 spectral meas-
ures to 4 and were efficient in characterizing most of the known
age-­effects, sex-­differences and cognitive correlates of sleep EEG.
Future clinical and basic studies are supposed to be significantly em-
powered by the efficient data reduction provided by our approach.
Disclosure: Nothing to disclose.
P119 | Investigating top-­down processing from
wakefulness to sleep: behavioural results of a
novel auditory paradigm in wakefulness
P. Topalidis; M. Ameen; T. Hauser; D. Heib; M. Schabus
Salzburg University, Salzburg, Austria
Objectives/Introduction: According to the predictive coding frame-
work, sensory stimuli travel up the cortex as a prediction error signal
updating the brain's top-­down representation of previous experi-
ences. Although such information processing mechanism has been
extensively investigated in wakefulness, little is known about how
this operates during sleep. The current project aims at investigat-
ing whether the ability of the brain to a) built sensory top-­down
predictions, and b) use such predictions to control the processing
of incoming sensory stimuli, persist during sleep. Here, we present
preliminary behavioural data of a novel auditory paradigm, which
combined with EEG can be used to investigate the operation of such
mechanism during sleep.
Methods: We developed an auditory task in which we parametri-
cally manipulated sensory evidence (i.e., stimulus intensity in terms
of sound pressure level) and expectations (i.e., stimulus predictabil-
ity) while measuring high-­density EEG in awake human participants.
In either predicted or random letter-­sequences (same vs different
letters) of 9 trials, the clarity of auditory stimuli increases gradually
from trial 1 to 5 and then decreases from trial 5 to 9. The ascending
part of the sequence (1–5) traces the build-­up of top-­down predic-
tions until a precept is created (trial 5).The descending part (5–9)
tests the effect of top-­down predictions on the threshold of per-
ceptual awareness. Analysis of Reaction Times (RTs) and perceptual
awareness reports are here presented.
Results: Preliminary behavioural results during wakefulness show
that in the descending part participants (N = 10) report higher per-
ceptual clarity or ‘confidence’ for the predicted compared to ran-
dom sequences (t(9) = 3.86, p < 0.001) which is further supported
by shorter RTs for the predicted sequences (t(9) = −7.73, p < 0.001).
Importantly, similar effects where not observed in the ascending
part of the sequence, for neither perceptual awareness (t(9) = 0.3,
p > 0.5) nor RTs (t(9) = −0.1, p > 0.05). Analyses of the event-­related
potentials (ERPs) that drive these behavioural effects are ongoing.
Conclusions: Behaviourally this novel auditory paradigm allows for
investigating not only the generation but also the utilization of pre-
dictions over incoming sensory signal. The ERPs that drive these
behavioural effects will be used to index differential processing of
predictable and unpredictable incoming sensory information during
sleep.
Disclosure: Nothing to disclose.
P120 | Predicting slow wave sleep through a
topographic template of slow oscillations
K.D. Fehér1; S. Ruch2; F. Schmidig2; Y. Morishima1; M.A.
Züst3; C. Mikutta1,4; E. Hertenstein1; C. Schneider1; C.
Nissen1
1
University of Bern, University Hospital of Psychiatry and
Psychotherapy; 2Institute of Psychology, University of Bern;
3
University of Bern, University Hospital of Old Age Psychiatry and
Psychotherapy, Bern; 4Privatklinik Meiringen, Meiringen, Switzerland
Objectives/Introduction: Modulation of slow wave sleep (SWS) is
promising for clinical adaption. However, methods are needed for
automatized detection of SWS to allow for broader implementation.
Here we evaluate the use of a topographical template of frontal slow
waves as a means to predict SWS. During SWS, correlation with
the topographical template will fluctuate in a slow oscillation (SO)
rhythm. The primary advantage of evaluating a correlation is that it is
insensitive to differences in slow wave amplitudes within individuals
(e.g. throughout the night) as well as between individuals (e.g. young
versus elderly). Here we tested the hypothesis that using correlation
with the topographical template (‘template-­based method’) is supe-
rior to using classical spectral characteristics of EEG data (‘spectral
method’) in automatically detecting SWS.
Methods: We used a previously established topographical template
of frontal slow wave peaks based on the detection of single peaks
at frontal EEG electrodes. Data from 12 healthy young participants
with two sleep laboratory nights each were used to evaluate SWS
classification performance, trained on visually staged data. We per-
formed lasso regression with a 5-­fold cross-­validation on the train-
ing data to obtain penalized, maximum-­likelihood fitted regressor
coefficients. We chose regressor coefficients corresponding to the
Lambda with minimum expected deviance.
ABSTRACTS
Results: The template-­based method demonstrated a better com-
posite sensitivity/specificity metric compared to the spectral method
(macro F1 score, 0.81 versus 0.78). Furthermore, the template-­based
method showed significantly fewer false positives (signed rank test,
p < 0.0001) and a more robust performance (lower variance) com-
pared to the spectral method.
Conclusions: The template-­based method produced substantially
better and more robust performance metrics compared to the spec-
tral method. Further developments of the template-­based method
bear the potential for translation to broader and even ambulatory
use of automated SWS detection and modulation.
Disclosure: Nothing to disclose.
P121 | Gender analysis of the clusters of sleep
apnoea phenotypes from the ESADA database
A. Pataka1; S. Bailly2; J.L. Pepin2; S. Schiza3; I. Bouloukaki3;
J. Verbraecken4; G. Trakada5; S. Ryan6; R. Riha7; P.
Steiropoulos8; L. Grote9; J. Hedner9; M.R. Bonsignore10; On
behalf of the ESADA Network
1 Disclosure: Nothing to disclose.
G. Papanikolaou General Hospital, Aristotle University, Thessaloniki,
2
Greece; Grenoble University Hospital, University Grenoble Alpes,
Grenoble, France; 3Sleep Disorders Center, Department of Respiratory
Medicine, University of Crete, Heraklion, Greece; 4Antwerp University
5
Hospital, University of Antwerp, Antwerp, Belgium; Pulmonary
Medicine, National and Kapodistrian University of Athens, Athens,
Greece; 6Department of Respiratory and Sleep Medicine, St. Vincent's
University Hospital, Dublin, Ireland; 7Department of Sleep Medicine,
University of Edinburgh, Edinburgh, United Kingdom; 8Sleep Unit,
Department of Pneumonology, Democritus University of Thrace,
Alexandroupolis, Greece; 9Department of Sleep Medicine, Sahlgrenska
University Hospital, Gothenburg University, Gothenburg, Sweden;
10
PROMISE Department, University of Palermo, Palermo, Italy
Objectives/Introduction: We previously conducted a cluster analy-
sis in OSA patients registered in the multinational European Sleep
Apnoea Database (ESADA). The current study investigated gender
differences within the same cluster and between clusters.
Methods: Latent class analysis to identify OSA phenotypes was ap-
plied to data from 23,139 patients referred to 30 centres reporting
to the ESADA.
Results: There were eight clusters with gender based differences;
two with males only (Cluster 2, ‘Older obese men’, N = 2980 and
Cluster 6, ‘Younger overweight men’, N = 5509). Two clusters con-
tained only women (Cluster 7, ‘Overweight women’, N = 2296 and
Cluster 8, ‘Older obese women’, N = 1719). The four remaining,
clusters contained a mix of both sexes and various combinations
of age, Body Mass Index, Apnoea-­hypopnea Index (AHI) and co-­
morbidities. In Cluster 1 ‘Young sleepy obese’ (N = 3834), female
patients (N = 359)) were more obese (p < 0.01), sleepier and had a
higher AHI as well as ODI (Oxygen Desaturation Index) (p < 0.01).
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However, men in this cluster had higher prevalence of hypertension,
hyperlipidemia, hyperuricemia and metabolic disease (p < 0.01). In
cluster 3, ‘Obese comorbid’, (N = 792), female (N = 214) patients were
older (p < 0.01), had a lower AHI (p < 0.01) and almost similar ODI
(p = 0.05). However, women had a higher prevalence of psychiat-
ric disease compared with men (p = 0.03). In cluster 4 ‘Older over-
weight’, (N = 5468), females (N = 1482) were older (p < 0.01), but
had similar AHI, ODI and comorbidities as hypertension, stroke, and
hyperlipidemia with men. However, asthma and psychiatric disease
were more prevalent (p < 0.01 and p < 0.01, respectively). In Cluster
5 ‘Pulmonary diseases’ (N = 541), women (N = 176) were older
(p < 0.01), more obese (p < 0.01), had a lower AHI (p < 0.01) along
with less smoking (p < 0.01), hyperlipidemia (p < 0.01), hyperuricemia
(p = 0.02) and COPD (p < 0.01) than men. However, asthma (p < 0.01)
and psychiatric disease (p < 0.01) were more prevalent.
Conclusions: Cluster formation in a large clinical cohort of patients
with OSA generated unique phenotypic clusters which contained
patients with substantial gender specific differences. The findings
suggest that different clinical approaches targeting a specific phe-
notypic cluster should take the possibility of gender specific differ-
ences into consideration
P122 | Mandibular advancement devices
effects on temporomandibular disorder signs
and symptoms: a systematic review and meta-­
analysis
A. Alessandri-Bonetti
Dentistry, Catholic University of Sacred Heart, Rome, Italy
Objectives/Introduction: The clinical practice guidelines do not
give precise indications on the use of mandibular advancement de-
vices (MAD) for obstructive sleep apnea (OSA) patients suffering
from musculoskeletal disorders of the masticatory system, called
temporo-­mandibular disorders (TMD). The aim of this systematic
review was to evaluate the effects of MADs on incidence and preva-
lence of TMD in adult OSA patients.
Methods: This systematic review protocol was registered under
PROSPERO register. A systematic research was carried out in sev-
eral databases. All types of studies evaluating TMD incidence and
prevalence on adult patients wearing MAD for OSA were included
and independently evaluated by two investigators. The quality of
evidence was evaluated using the grading of recommendations as-
sessment, development and evaluation and the risk of bias by the
risk of bias in non-­randomized studies of interventions tool or the
Cochrane collaboration′s tool. For each study included, the differ-
ence in means and 95% CI was calculated between baseline and
follow-­up.
Results: The search allowed to identify 2474 citations, of which 12
met the inclusion criteria. A total of 718 patients were analyzed for
 |
130 of 356       ABSTRACTS
a follow-­up period going from a minimum of two months up to five
years.
The meta-­analysis was carried out and the odds ratio evaluation re-
vealed that MADs do not represent a risk factor for TMD signs and
symptoms. On the contrary, most of the studies showed that the
use of MAD might represent a protective factor for TMD signs and
symptoms.
When analyzing studies which excluded patients with TMD signs or
symptoms prior to the treatment beginning the incidence of TMDs
during MAD therapy was calculated between 18.6% and 40.9%.
Conclusions: The analysis of scientific literature evaluating the ef-
fects of MADs on TMD in patients showed that patients with pre-­
existing signs and symptoms of TMD do not experience significant
exacerbation of those using MAD, while TMD free patients may de-
velop some kind of TMD during treatment. Therefore the presence
of TMD should not be considered a routine contraindication for the
use of MADs in the management of OSA.
Disclosure: Nothing to disclose.
P123 | The interacting effects of age and HIV
status on chronotype in a rural South African
population
K. O'Brien1; F.X. Gomez-Olivé2; N. Riddell1; D. Rae3; K.
Scheuermaier2; M. Von Shantz1
1 2
University of Surrey, Guildford, United Kingdom; University of the
Witwatersrand, Johannesburg; 3University of Cape Town, Cape Town,
South Africa
Objectives/Introduction: Sleep disturbances are highly prevalent in
people living with HIV. However, the aetiology of these disturbances
is not well characterised. Existing literature suggests associations
with later chronotype and poorer sleep quality. This study aimed to
assess whether HIV status is associated with chronotype in an ef-
fort to describe a possible explanation for the prevalence of sleep
disturbances.
Methods: Participants (N = 242; aged 64.4 ± 11,2; 164 females) who
had completed the Munich Chronotype Questionnaire (MCTQ) as
part of a cohort study conducted in Agincourt, South Africa, were
selected for this study. HIV status and general demographic data for
each participant were obtained from medical records collected as
part of the study. Of the participants, 63 were HIV positive, and 179
were HIV negative.
Results: Chronotype for each participant was determined by the
midsleep point on free days, corrected for sleep debt on work days
(MSFsc), obtained from the MCTQ. The population MSFsc mean was
1.08; SD ± 0.75. A general linear model (GLM) looking at effects of
HIV status on chronotype was performed, controlling for age and
sex. Due to the known relationship between age and chronotype,
interacting effects between HIV status and age were also assessed.
The GLM revealed a significant relationship between HIV status
and chronotype (F(4,237) = 4.578; p = 0.001). Moreover, the model
revealed a significant interaction between HIV status and age on
chronotype (p = 0.004). Importantly, age alone was not a significant
predictor in the model.
Conclusions: HIV positive participants had a significantly later
chronotype, compared with HIV negative participants, with the ef-
fect being more pronounced in younger participants. This finding has
two possible explanations. Firstly, HIV infection may impact phase
of the internal biological clock, producing a shift in chronotype.
However, this finding may reflect the possibility that people with a
later chronotype are more likely to become infected with HIV, due to
increased activity in the evening hours. To tease out true cause and
effect, further studies should include measures of circadian phase,
as well as a longitudinal component to capture chronotype prior to
HIV infection.
Disclosure: Nothing to disclose.
P124 | Post-­learning resting-­state functional
connectivity and sleep spindles activity
contribute to procedural memory consolidation
in young and older adults
A. Mary1; A. Budzińska1; V. Wens2; M. Gilson1; R. Leproult1;
J. Farthouat1; X. De Tiège3; P. Peigneux1
1
Neuropsychology and Functional Neuroimaging Research Unit;
2
Laboratoire de Cartographie fonctionnelle du Cerveau and MEG Unit;
3
Laboratoire de Cartographie Fonctionnelle du Cerveau and MEG Unit,
Université Libre de Bruxelles, Brussels, Belgium
Objectives/Introduction: This study investigated the contributions
of resting-­state sensorimotor networks and post-­training sleep oscil-
lations to the consolidation of procedural motor sequence learning,
in 11 healthy young (19–25 years) and 10 older (65–74 years) adults.
Methods: Resting-­state functional connectivity (rsFC) was meas-
ured using magnetoencephalography (MEG; Elekta Neuromag) im-
mediately before and after learning. Right primary sensorimotor
cortex (rSM1) seed-­based rsFC maps were computed using envelope
correlations during pre-­and post-­learning sessions. Post-­learning
rsFC modifications were compared between Young and Old par-
ticipants; results are reported after correction for multiple com-
parisons in source-­level statistical maps (pcorr< 0.05). Post-­learning
sleep was recorded using ambulatory polysomnography (Morpheus
Micromed). Spectral power was computed during NREM sleep, and
spindles were detected during N2 sleep stage from central elec-
trodes using the automatic algorithm implemented in YASA toolbox
(https://doi.org/10.5281/zenodo.2370600). Pearson correlations
were computed over the entire population to test whether age-­
related changes in post-­learning rsFC and sleep are predictive of of-
fline changes in performance 3 nights after learning.
Results: Although old participants had no sleep complaints, 7 out
of the 10 old participants presented obstructive sleep apnea (OSA).
ABSTRACTS
Motor memory performance at Day 4 declined in Old as compared
to Young adults (p < 0.01). Sleep in Old (vs. Young) adults was char-
acterized by increased intra-­sleep awakenings, %N1, alpha power
and apnea/hypopnea index (AHI), and decreased %N3, spindles du-
ration and spindles amplitude (ps  <  0.044). Memory consolidation
(% change from learning to retest) correlated with spindles duration
(r = 0.55, p = 0.01) and AHI (r = −0.56, p = 0.01) on the post-­training
night. MEG data disclosed age-­related changes in rsFC immediately
after learning, between the rSM1 seed and the precuneus, prefron-
tal and sensorimotor-­related regions (pcorr< 0.05). The rsFC changes
in these sensorimotor regions positively correlated with memory
consolidation after 3 nights and rsFC changes in the precuneus with
sleep spindles duration (ps = 0.009–0.03).
Conclusions: Our results suggest that both the plasticity of the
sensorimotor network immediately after learning and sleep spin-
dles during the post-­learning night contribute to the stabilization of
memory performance up to 3 nights after learning both in young and
old adults. The presence of OSA symptoms in Old participants may
explain a negative outcome on memory consolidation.
Disclosure: Nothing to disclose.
P125 | Renalase and hypertension -­
demographic and clinical correlates in obstructive
sleep apnea
H. Martynowicz1; K. Czerwińska2; A. Wojakowska1; L.
Januszewska2; I. Markiewicz-Górka2; M. Więckiewicz3; G.
Mazur1; K. Pawlas2; R. Poręba1; P. Gać2
1
Department and Clinic of Internal and Occupational Diseases,
Hypertension and Clinical Oncology; 2Department of Hygiene;
3
Department of Experimental Dentistry, Wroclaw Medical University,
Wroclaw, Poland
Objectives/Introduction: Renalase plays an important role in blood
pressure regulation. Obstructive sleep apnea (OSA) is a common res-
piratory disorder associated with hypertension and cardiovascular
complications. The aim of the study was to assess the relationship
between sleep apnea and renalase concentration in order to clarify
pathogenesis of OSA and its complications.
Methods: Adult patients (n = 113) were evaluated for OSA in a sleep
laboratory using polysomnography. The respiratory events were
scored according to the standards of the American Academy of
Sleep Medicine. The levels of serum renalase were measured in the
patients using enzyme-­linked immunosorbent assay kits.
Results: OSA (apnea-­ hypopnea index (AHI)  ≥  5) was diagnosed in
71.42% (n = 80) of studied population. We have observed signifi-
cant difference in renalase concentration in the group with moder-
ate and severe OSA (AHI  ≥  15) compared to group with AHI  <  15
(139.56 ± 175.72 vs 221.76 ± 233.23, p = 0.044). We have found
negative linear correlation between renalase and AHI in hyper-
tensives, but not in normotensives. The linear negative correlation
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was observed between AHI and renalase in whole studied group, in
males, and in the group of age < 60 years old. There was not such a
correlation in females and in the group > 60 years old. Based on the
regression model, it was shown that decreased renalase, hyperten-
sion, higher BMI, male gender constitute independent risk factors
for the increased AHI.
Conclusions: There exists an association between renalase concen-
tration and OSA severity, which may influence hypertension devel-
opment in OSA.
Disclosure: Nothing to disclose.
P126 | Adjusted CBT-­i for sleep problems in
bipolar disorder -­results from a pilot study
S. Jernelöv1; J. Gatzacis2; J. Killgren2; L. Ledin2; V. Kaldo1,3
1
Karolinska Institutet; 2Stockholm County Council, Stockholm;
3
Linnaeus University, Växjö, Sweden
Objectives/Introduction: Cognitive Behaviour Therapy for insom-
nia (CBT-­i) is an effective treatment with a solid research base, that
holds promise also when insomnia is co-­morbid, but in psychiatric
populations its effectiveness and usefulness is not yet thoroughly
established.
This study examines whether a version of CBT-­i, adjusted for pa-
tients with bipolar disorder, can be used in the clinic sleep as a group
treatment. The pilot study was conducted at two specialist psychiat-
ric out-­patient clinics for bipolar disorder, within Stockholm County
Council.
The aim was to investigate if sleep problems improved in the patient
group after treatment, and if bipolar symptoms were affected.
Methods: In this within-­group pilot study, participants were given a
group treatment based on CBT-­i and adjusted for patients with bi-
polar disorder. Measurements with the Insomnia Severity Index (ISI)
and Affective Symptoms Scale (AS-­18) were conducted pre and post
treatment, and the ISI also at three-­month follow-­up.
Results: Preliminary analyses indicate that participants (n = 34) im-
proved in insomnia severity from pre-­treatment to post-­treatment
(pre ISI = 17.3, SD = 5.7 à post ISI = 11.1, SD = 5.7, p = 0.000), and that
improvements were maintained at three-­month follow-­up (post ISI à
fu3 ISI = 10.2, SD = 5.9, p = 0.490). Depressive symptoms were im-
proved at three-­month follow-­up as compared to pre-­treatment (pre
AS-­18 (dep) = 12.4 à fu3 AS-­18 (dep) = 8.3, p = 0.023), while manic
symptoms were not statistically significantly improved (pre AS-­18
(mania) = 7.0, post AS-­18 (mania) = 6.2, fu3 AS-­18 (mania) = 4.5,
ps > .05).
Conclusions: CBT-­i adjusted for bipolar disorder is promising for
improving insomnia severity in adult patients in specialist psychi-
atric out-­patient care, who suffer from bipolar disorder and sleep
disturbances.
Disclosure: Nothing to disclose.
 |
132 of 356       ABSTRACTS
P127 | Sleep disturbances and mental disorders
in help-­seeking unaccompanied refugee minors
A.A. Schlarb1; L. Holdmann2; M. Bünnemann2
1
Psychology | Clinical Psychology and Intervention; 2Bielefeld
University, Bielefeld, Germany
Objectives/Introduction: Unaccompanied Refugee Minors (URM)
are at high risk for mental disorders due to traumatic experiences
and loss of their primary caregivers. Significantly more (97% of URM)
than accompanied refugee minors report having had traumatic ex-
periences (often war experiences). As a result URM show higher
levels of mental health symptoms than accompanied refugees or na-
tive adolescents. Most common mental health problems of URM are
posttraumatic stress symptoms and internalizing symptoms, such as
anxiety and depression. Beyond, URM often report sleep problems.
Therefore the objectives of this study were to assess the intercon-
nections of PTSD symptoms and sleep problems (nightmares and
short sleep) with suicidal ideation while controlling for comorbid de-
pressive symptoms in help-­seeking URM of a specialized out-­clinic
ambulance.
Methods: Cross-­sectional study with N  =  78 help-­seeking URM,
mean age = 17.09 years (SD = 1.54) with the youngest being 12 and
the oldest 21 years. Various adapted questionnaires as the Reactions
of Adolescents to Traumatic Stress questionnaire (RATS) and the
Hopkins Symptom Checklist 37A (HSCL-­37A) were implemented to
assess the addressed topics.
Results: Multiple linear regression analyses showed a signifi-
cant impact of depression on suicidal ideation (β = .327, p  <  0.05).
Nightmares rs = .424, p < 0.001, short sleep (rs = -­. 277, p = 0.022) and
PTSD were significantly associated with suicidal ideation, but when
controlling for depression only sleep problems p = 0.019 stayed sig-
nificant predictors of variance in suicidal ideation. Hopelessness did
not mediate the link between nightmares and suicidal ideation. Short
sleep p  =  0.012 but not nightmares mediated the PTSD -­suicidal
ideation link.
Conclusions: Nightmares, short sleep and depression are uniquely
linked with suicidal ideation in help-­seeking URM. Based on these
findings, sleep duration and sleep quality and disorders should be
assessed in URM to adapt treatment options.
Disclosure: Nothing to disclose.
P128 | One case of a non-­24 hour sleep-­wake
disorder treated by total sleep deprivation
followed by combination of chronobiotic
treatments
K. Guichard1,2; J.-A. Micoulaud-Franchi1,2,3; P. Philip1,2,3; J.
Taillard2,3
1
Clinique du Sommeil, EFSN, CHU Bordeaux; 2SANPSY, USR 3413,
Bordeaux University; 3SANPSY, USR 3413, CNRS · Centre de
Recherche en Neurosciences, Bordeaux, France
Objectives/Introduction: Non-­24-­hour sleep-­wake disorder
(N24SWD) is one of several chronic circadian rhythm sleep disor-
ders (CRSDs). It is defined as a ‘chronic steady pattern comprising
daily delays in sleep onset and wake times in an individual living in
society’. This sleep disorder affecting essentially blind persons, are
relatively rare in sighted patients and are difficult to treat, with no
clinical practice guidelines for treatment.
Methods: We report a case of N24SWD in a sighted, 26 years old
man, who was referred to the sleep unit of Bordeaux University hos-
pital, for complains of alternance of severe insomnia and excessive
sleepiness. He had a diagnosis of mood disorder (stabilized) and no
other medical history. Diagnosis and follow up were confirmed by
sleep diary and 30 days of actigraphic monitoring (Motion watch 8)
Results: Sleep agenda and an actigraphy showing a daily delay by
approximately 1 h each day, confirming the diagnosis of N24SWD.
To reset daily delay, a 36 h total sleep deprivation (TSD) was im-
plemented during hospitalisation. This TSD was followed by combi-
nation of treatments: fixed regular sleep/wake schedules, morning
light therapy (45 mn, 10000 lux) and oral administration of melatonin
(2 mg) 1 h prior to bedtime. Initial complaints were improved quickly
and sleep diary and actigraphy showed a complete realignment of
the sleep-­wake rhythm without relapse for 6 months at least.
Conclusions: This case brings one well documented and treated case
about the extremely rare disease of N24SWD in sighted people.
N24SWD represent an inability of the circadian clock to maintain
synchrony among internal and external 24-­hours rhythmic functions
underlies by clock genes and their products. TSD, altering clock gene
process, suggest the possibility to do a circadian machinery reset
and improve circadian synchronisation in N24SWD. In this case we
found a very quick and efficient improvement without side effect. It
revealed the efficacy of TSD followed by use combination of chrono-
biotic treatments in N24SWD, with cessation of the free running
pattern and a long term retention.
Disclosure: Nothing to disclose.
ABSTRACTS
P129 | Circadian and homeostatic processes in
delayed sleep-­wake phase disorder patients
C. Reis 1,2,3 3
; S. Rebocho ; T. Paiva 3,4
1
ISAMB -­Faculdade de Medicina, Universidade de Lisboa; IMM 2
3
-­Faculdade de Medicina, Universidade de Lisboa; CENC -­Sleep
4
Medicine Center; CHRC -­Nova Medical School, Lisboa, Portugal
Objectives/Introduction: Delayed sleep phase disorder (DSWPD)
is characterised by a delay on their sleep and wake schedules.
Approximately 50% of patients with DSWPD demonstrate a delay of
their circadian and sleep-­wake times, with a normal phase angle (DLMO
time 2–3 h before bedtime), while others demonstrate a normal circa-
dian time based on DLMO (20:00 h-­23:00 h) but a delay in sleep-­wake
timing. The objective of this work was to calculate the phase angle dif-
ference between PSG sleep onset time (PSG_SO) (without social influ-
ence) and DLMO and see how homeostatic (e.g. sleep latency, SWS)
and circadian (DLMO) indicators vary among DSWPD patients.
Methods: DSWPD clinical database diagnosed by a sleep medicine
specialist from a Portuguese Sleep Medicine Center (CENC). 95 pa-
tients performed sleep diary, PSG type I and salivary DLMO meas-
urement. Three groups of patients were established according to
phase angle between PSG_SO and DLMO: G1: misaligned (SO be-
fore DLMO), G2: Aligned (SO 0H-­3 h after DLMO), G3: misaligned
(SO > 3 h after DLMO). A multivariate general linear model was per-
formed with SPSSv25. Results were significant for p < 0.05.
Results: No age differences were found among groups. DLMO was
different for all groups (p < 0.001) with the latest values in G1 and
the earliest in G3. For G3 PSG_SO was later (p = 0.010) and DLMO
time was earlier (p < 0.001). For G3, N3% was lower but this value
was influenced by age (p = 0.514).
Conclusions: G1 have an extreme late biological night but their homeo-
static pressure is high since when without social clues, they can initiate
sleep even before the start of their biological night marker (DLMO).
G3 have a low homeostatic pressure since even during their biological
night and without social influences they can't initiate sleep, sleeping
later during the night, like their in-­home reported sleep onset time.
Disclosure: Nothing to disclose.
P130 | Narcolepsy treatments: comparison of
pitolisant, modafinil and sodium oxybate via a
network meta-­analysis
1 2,3
C. Caussé ; P. Lehert
1
Bioprojet Pharma, Paris, France; 2Faculty of Medicine, University
of Melbourne, Melbourne, VIC, Australia; 3Faculty of Economics,
University of Louvain, Mons, Belgium
Objectives/Introduction: Narcolepsy is characterized by the exces-
sive daytime sleepiness (EDS) measured by the Epworth Sleepiness
|
      133 of 356
Scale (ESS) and/or the Maintenance Wakefulness Test (MWT)
and the cataplexy attacks rate (CAR). We performed a Multiple-­
Treatment comparison of three main treatments on EDS, CAR and
Safety in randomized clinical trials (RCTs) through a Network meta-­
analysis (NMA).
Methods: A protocol was prepared according to meta-­
analyses
guidelines. Study selection was all RCTs conducted in adult nar-
coleptic patients (ANP) assessing at least one of the 3 treatments
and placebo. Univariate meta-­analyses were performed separately
for ESS, MWT and CAR, and confirmed by a multivariate compari-
son based on an aggregating Z-­score. Safety index was the Adverse
Events incidence (AEI). Finally, a Risk/Efficacy index was calculated as
a summary mean of Efficacy and Safety Z-­score. A NMA was needed
due to the multiple treatment comparison and multi -­arm studies
needing correction on correlation matrix. The random model was as-
sumed due to the expected between studies heterogeneity.
Results: In ANP, Modafinil/Armodafinil (MDF), sodium oxybate
(SXB) and Pitolisant (P), demonstrated their efficacy to reduce EDS;
P and SXB demonstrated their efficacy to reduce CAR. 14 studies
were included in the NMA, 6 treatments groups were considered:
MDF 200–400 mg/d, SXB 6 g/d (SXB6) and 9 g/d (SXB9) and P up
to 20 mg/d (P20) and up to 40 mg/d (P40), and placebo. Placebo was
considered as the reference value. SXB9, MDF and P40 were signifi-
cantly different from placebo for ESS, MWT and CAR. In the ranking
of treatments performed according to P-­scores (Equivalent Sucra
Values) and for all the efficacy endpoints confirmed by the multivari-
ate meta-­analysis, the highest treatment effect was found for P40,
followed by SXB9 and MDF. The best safety profile compared with
placebo was for Pitolisant (all doses), followed by Modafinil. SXB was
characterized by a higher AEI. Finally, the best Risk/Benefit index
was observed with P40.
Conclusions: This network meta-­analysis provides evidence of the
superiority of Pitolisant up to 40 mg/d over Modafinil or Sodium
Oxybate on efficacy (EDS,CAR) and safety.
Disclosure: Bioprojet pharma sponsored this analysis. C Caussé is
an employee of bioprojet pharma. P Lehert received honoraria from
bioprojet.
P131 | Technology usage predicts increased
health risks, mediated by weekday and weekend
sleep in adolescents
C. Holden; J. Groeger
Psychology, Nottingham Trent University, Nottingham, United Kingdom
Objectives/Introduction: The effect of technology on sleep has
been well documented. Often, a small number of sleep variables are
measured. This study has investigated the relationships between
technology usage, sleep and health risk predictors. We hypothesise
that technology usage will negatively predict health risk factors
which will be mediated by weekday and weekend sleep.
 |
134 of 356       ABSTRACTS
Methods: Four Hundred and five adolescents undertook a survey
consisting of: Subjective Sleep (including weekday and weekend
equivalents of Sleep Quality (SQ), Waking Feeling Refreshed (RuA)
and Sleep Duration (SD)); Cleveland Adolescent Sleepiness Scale -­
modified (Sleepiness at School, Sleepiness at the Weekend (SAW),
Alertness at School, Alertness at the Weekend and Sleepiness in
Evenings), Frequency of Phone Checking Having Awoken from Sleep
(FOPC) and Hospital Anxiety and Depression Scale.
Results: Weekday SD and SQ fully mediated the relationship be-
tween higher FOPC and depression (c = 4.36, p = 0.04, (ab = 2.56).
Participants who had higher FOPC had a shorter weekday SD (a1 =
-­1.17, p = 0.03), those who had higher FOPC had poorer weekday
SQ (a2 = 1.88, p = 0.0004), those who had shorter weekday SD had
poorer weekday SQ (a3 = -­0.40, p < 0.0001), those who had shorter
weekday SD were more depressed (b1 = -­0.7, p = 0.007), those who
had poorer weekday SQ were more depressed (b2 = 0.74, p = 0.003).
FOPC was related to higher depression mediated by weekday SD
and SQ.
FOPC indirectly increased anxiety through its effect on week-
day RuA and SAW (c = 0.77, p = 0.71, ab = 2.80). Participants who
had higher FOPC had poorer weekday RuA (a1 = 2.29, p = 0.0003),
those who had higher FOPC had higher SAW (a2 = 4.10, p = 0.002).
Participants who had poorer RuA were more anxious (b1 = 0.87,
p < 0.0001) and participants with higher SAW were more anxious
(b1 = 0.19, p = 0.05).
Conclusions: These findings show greater technology usage pre-
dicts higher depression and anxiety via reduced SQ, SD, RuA and
higher SAW. Research should begin to investigate a wider range of
sleep variables.
Disclosure: Nothing to disclose.
P132 | Sleep does not facilitate human
fear memory consolidation
1,2 1 formation is rapidly acquired when it is compatible with previously
Y.G. Pavlov ; B. Kotchoubey
1 learned and consolidated knowledge (i.e., an acquired schema).
University of Tuebingen, Tuebingen, Germany; 2Ural Federal
University, Yekaterinburg, Russian Federation
Objectives/Introduction: The positive effects of sleep on the con-
solidation of declarative memories are generally well known. The
role of sleep in consolidation of fear memories has not received as
much attention. Moreover, only a few studies in humans have used
physiological indices of conditioning, and none used central physi-
ological measures. In the current study we investigated how sleep
affects (1) consolidation of fear memories on behavioral level and
(2) central measures of fear conditioned response by means of EEG.
Methods: In our experiment event-­related brain potentials (ERP)
were recorded during a fear conditioning procedure presented twice,
before and after sleep or control intervention in 18 healthy young
individuals. The procedure involved pairing of a neutral tone (CS+)
with a highly unpleasant sound (UCS+). As a control, another neutral
tone (CS-­) was paired with a neutral (for some subjects slightly pleas-
ant) sound (UCS-­). The two sessions of conditioning were separated
by approximately 2.5 hours when: on one experimental day subjects
watched a silent movie for 2 h (wake intervention); on another day
the participants had 2 h sleep opportunity (sleep intervention). The
two days were separated by at least two weeks and counterbalanced
in respect to the stimulus mapping.
Results: In EEG differential conditioning manifested itself in the
contingent negative variance (CNV)-­
like slow ERP component.
Both period of sleep and wakefulness resulted in increased ampli-
tude of the CNV to CS+ (main effect of contingency F(1,17) = 17.6,
p < 0.001) without a significant difference between the type of in-
tervention. The same effect was obtained on the behavioral level,
with Valence ratings of CS+ were more negative as compared to CS-­
(F(1,17) = 14.9, p < 0.001). The intervention (sleep/wake) followed by
a block of extinction learning. Relearning of fear after the extinction
elicited stronger differential response in CNV (main effect of Time
(before-­after comparison) F(1,17) = 6.5, p = 0.02) but not in the be-
havioral ratings (F(1,17) = 0.66, p = 0.426).
Conclusions: The data indicate that fear memories are consolidated
with the course of time with no beneficial effect of sleep or a period
of wakefulness.
Disclosure: Nothing to disclose.
P133 | Effect of sleep on schema-­mediated
motor memory consolidation
S. Reverberi; B.R. King; G. Albouy
Department of Movement Sciences, Motor Control and Neuroplasticity
Research Group, KU Leuven, Leuven, Belgium
Objectives/Introduction: The speed with which we acquire new
knowledge critically depends on what we already know: new in-
Previous research examining this ‘schema effect’ in the declarative
memory domain has demonstrated that sleep facilitates the rapid
integration of new information that is compatible with an exist-
ing schema. Considerably less is known about sleep and schema-­
facilitated integration in the motor memory domain; this knowledge
gap is the focus of the current research.
Methods: Participants (N  =  28) performed a bimanual serial reac-
tion time task (SRTT), in which they learned a motor sequence by
responding to visual cues on the screen as quickly and as accurately
as possible, both before and after a 90-­minute period of either sleep
or quiet wakefulness. Nap and wake episodes were monitored with
standard polysomnography (10–20 system, 6 scalp electrodes).
Critically, although the sequences performed in the two sessions
were different, they were highly compatible with respect to their
underlying structure, allowing us to examine the effect of sleep on
the integration of novel, compatible motor sequence information.
ABSTRACTS
Results: Analyses of this preliminary set of data (NAP group = 14,
WAKE group = 14) indicate that performance on the novel motor se-
quence transitions, reflecting schema integration processes, was on
average better following a nap as compared to quiet wakefulness, al-
though the difference was not significant in this preliminary sample
(p = 0.33). Furthermore, performance on novel transitions showed
a trend for a significant relationship with sleep latency (p = 0.065),
suggesting that shorter sleep latency aids learning of novel schema-­
compatible information.
Conclusions: Our preliminary results suggest that sleep may aid in
the formation of motor schemas, thus promoting fast learning of
novel schema-­
compatible information. While effects of specific
sleep features such as spindles and slow oscillations to this motor
memory enhancement have yet to be investigated, preliminary data
indicate that decreased sleep latency is correlated with increased
memory integration.
Disclosure: The authors declare that there is no conflict of interest.
This research was supported by grant G0B1419N, ‘Speeding Up the
Learning Process: A Multimodal Neuroimaging Investigation into
the Acceleration of Motor Memory Consolidation’, FWO Research
Project. Granted in 2018.
P134 | Relationship between slow wave
activity during post-­motor learning sleep and
hippocampal responses is modulated by stress
N. Dolfen1; M.P. Veldman1; J. Nicolas1; L. Schwabe2; M.A.
Gann1; B.R. King1; G. Albouy1
1
Movement Sciences, KU Leuven, Leuven, Belgium; 2University of
Hamburg, Hamburg, Germany
Objectives/Introduction: Previous research has demonstrated that
stress modulates the relationship between motor sequence memory
processing over periods of sleep and hippocampal activity (Dolfen
et al., Submitted). Here, we investigated whether these stress-­
induced modulations of brain activity relate to specific markers of
plasticity during post-­encoding sleep.
Methods: Fifty-­five right-­handed, healthy participants (age range:
18–30) were exposed to stressful (i.e. socially evaluated cold pres-
sor test (SECPT)) or non-­stressful stimulation before being trained
on motor sequence learning task (MSL; 8-­element bimanual finger
tapping task). Participants were retested on the MSL task after a
90 min-­nap recorded with polysomnography. Slow wave activity
(SWA; 0.5–4 Hz) during post-­learning sleep was extracted over Fz
from artefact free NREM sleep episodes. During the MSL sessions,
functional BOLD images were acquired. MRI linear contrasts tested
the changes in practice-­related brain activity between training and
post-­sleep retest sessions. The resulting contrasts were entered in
a second level analysis (two-­sample t tests) using SWA as covariate.
Statistical inferences were made at the group level (p <  0.05 after
correction for multiple comparisons over small volumes (SVC)).
|
      135 of 356
Results: Results showed that the SECPT, as compared to the control
intervention, triggered significant increases in heart rate, blood pres-
sure and cortisol (two sample t-­tests, all ps ≤ .001). Offline changes in
performance speed from MSL training to retest, taken as an indica-
tor of memory processing over sleep, did not differ between stress
and control groups (two sample t-­test, ns). At the neural level, regres-
sion analyses showed that between-­session changes in task-­related
hippocampal activity differently correlated with SWA in the stress
and control groups (Z = 2.98, psvc = .034). Specifically, higher SWA
was associated with decreases in hippocampal activity from training
to retest in controls, while the opposite relationship was observed in
the stress group.
Conclusions: These results suggest that stress modulates the link be-
tween SWA during post-­learning sleep and changes in hippocampal
activity over the course of motor sequence memory consolidation.
Disclosure: Nothing to disclose.
P135 | Exposure to smartphone LED-­screens in
the evening and their impact on sleep-­dependent
memory consolidation
C. Hoehn; S.R. Schmid; K. Bothe; C. Plamberger; K.
Hoedlmoser
Psychology, University of Salzburg; Laboratory for Sleep, Cognition and
Consciousness Research, Salzburg, Austria
Objectives/Introduction: Exposure to short-­wavelength light during
the evening increases alertness and suppresses melatonin secre-
tion. Negative effects on sleep onset latency, sleep fragmentation,
early slow wave activity and slow wave sleep have been reported
previously. However, it is unclear whether these effects of short-­
wavelength light can affect overnight memory consolidation since no
research has been published on this topic yet. We assessed whether
exposure to smartphone screens during the late evening affects be-
havioural and physiological correlates of memory consolidation.
Methods: Data from 14 healthy men (21.93 ± 2.17 years) were ob-
tained from a within-­subjects design. Participants underwent three
experimental nights and read either a printed book or an e-­book on
a smartphone (Samsung Galaxy A50) with a blue-­light filter switched
on (spectral peak: 448 nm, illuminance: 8298K) or off (spectral peak:
613 nm, illuminance: 3032K). The reading sessions lasted 90 min-
utes and were implemented before bedtime under dim room-­lighting
(4.5lux). A declarative word-­pair learning task was administered be-
fore reading with an immediate recall after 30 minutes and a de-
layed recall the next morning. Overnight changes in remembered
word-­pairs served as a behavioural measure for memory consolida-
tion. During the first night-­quarter, peak-­to-­peak amplitudes of slow
oscillations, slow wave activity (SWA; 0.75–4.5 Hz) as well as sleep
spindle intensity and density were obtained from polysomnographic
recordings and served as physiological parameters.
 |
136 of 356       ABSTRACTS
Results: Memory performance increased overnight (p = 0.001) but
did not differ between reading conditions (p = 0.188). Frontal peak-­
to-­peak amplitudes of slow oscillations were reduced in the no-­filter
compared to the filter (p = 0.032) and the book (p = 0.065) conditions.
Effects on frontal SWA pointed into the same direction but failed
to reach statistical significance between the no-­filter and the filter
(p = 0.253) or the book (p = 0.131) conditions. Slow and fast spindle
activity did not differ between reading conditions (all p > 0.05).
Conclusions: Results suggest that short-­wavelength light emitted
by a smartphone negatively affects slow oscillatory activity during
the first night-­quarter. However, 90 minutes of exposure to short-­
wavelength light enriched LED-­smartphone screens seem to be in-
sufficient to exert further effects on sleep spindles or declarative
memory consolidation.
Disclosure: Nothing to disclose.
P136 | Polysomnography for everybody -­
validation of an open-­hardware board for
low-­cost sleep classification
D.P.J. Heib; M. Schabus
Centre for Cognitive Neuroscience, University of Salzburg, Salzburg,
Austria
Objectives/Introduction: In this paper, we validated the reliability
of a low-­cost (< 200 €) open-­hardware biosensing board (Ganglion,
openbci.com) for sleep stage classification.
Methods: We tested the device with generic signals and against
an industry reference device (BrainAmp Standard, BrainProducts,
Germany). Regarding the comparison to the reference device, we
recorded a full night polysomnography in parallel with both devices
using the same sensors as input channels. Signals of both devices
were sampled with 200 Hz, offline bandpass filtered between 0.5–
25 Hz and recording onsets were accurately adjusted. Automatic
sleep stage classification was performed separately for the signals
recorded with each device. In addition, signals were compared using
spectrograms and coherograms.
Results: Our analyses revealed strong correlations (rhoSWA = 0.92,
rhoTheta = 0.78, rhoAlpha = 0.92, rhoSigma = 0.93, rhobeta = 0.93, all
p < 0.001) and reasonable coherence values (CxySWA = 0.70, CxyTheta
= 0.73, CxyAlpha = 0.77, CxySigma = 0.79, CxyBeta = 0.79) across different
frequency bands, between the data recorded by the Ganglion and
the industry-­standard device. The tested board is capable to track
the typical course of spectral activity throughout the night, which
is one main feature standard automatic sleep classification rely on.
Nonetheless, overall sleep scoring agreement based on the data
recorded by both devices was only moderate (accuracy = 70.37%,
sensitivity = 65.32%, specificity = 91.66%.). The obtained low clas-
sification agreement was mainly caused by an attenuation of spec-
tral power in frequencies below 2 Hz by the Ganglion board which
consequently led to a significant underestimation of N3 sleep (sen-
sitivityN3 = 29.35%).
Conclusions: Overall, the signal quality of the tested low-­cost bio-
sensing board seems to be promising. However, in order to achieve
reasonable sleep scoring accuracy with standard scoring criteria,
the hardware filters need to be adequately adjusted or the recorded
data altered with an appropriate transfer function.
Disclosure: Nothing to disclose.
P137 | Chemotherapy reduces running wheel
activity and alters the strength of the output of
the circadian clock
Y. Wang; S. van Leerdam; S. van derZanden; E. Domenie; S.
Michel; Q. Walschots; J. Neefjes; J. Meijer; T. Deboer
Cell and Chemical Biology, Leiden University Medical Center, Leiden,
The Netherlands
Objectives/Introduction: Cancer related fatigue (CRF) is the most
common and distressing symptom reported by people living with
cancer. Over 50% of cancer patients suffer from CRF, which can
persist for months or even years after treatment completion. Some
patients with CRF also show disrupted sleep-­wake cycles and a weak
rest-­activity rhythm. One of the causes may be chemotherapy, how-
ever, research in humans is very difficult due to the confounding
influence of the disease itself. In this study, we want to establish a
chemotherapy induced CRF mouse model comparing three different
kinds of treatments.
Methods: 19 male C57BL/6J mice were implanted with EEG/EMG
electrodes and divided over 4 groups based on different chemo-
therapy treatments. Mice were injected with either Doxorubicin
(3.75 mg/kg), Aclarubicin (3.75 mg/ml), Etoposide (11.25 mg/ml) or
vehicle (control). Sleep-­wake states, locomotor activity in the cage,
and running wheel activity was recorded before and after treatment
under a 12:12 light-­dark(LD) cycle. To further analyse the circadian
rhythm the mice were released in constant dark (DD) conditions
after treatment. The strength of the circadian rest-­activity rhythm
was derived from F-­periodogram analysis. After the animals were
sacrificed ex vivo electrophysiological neuronal activity of the su-
prachiasmatic nuclei (SCN) neurons was recorded.
Results: The wheel running distance in both the Doxorubicin and
treated mice was significantly shorter (PDoxo=0,0267,
Etoposide-­
PEtop=0,0113; unpaired t-­
test) compared to control. The first
7 hour of the active phase, running was significantly decreased in
both Etoposide-­and Doxorubicin-­treated mice under LD and DD
condition. The strength of the circadian rhythm was reduced in
Doxorubicin-­treated mice under DD (p = 0.0119, unpaired t-­test)
compared to control. Analysis of sleep and SCN neuronal activity
data is in progress.
Conclusions: We have developed a model which seems to be able to
differentiate the effects of different chemotherapy treatments. Our
ABSTRACTS
current data demonstrate the Doxorubicin and Etoposide treated
mice display behaviour analogous to the symptoms of cancer-­
related-­fatigue in human patients. The results suggest that some
types of chemotherapy treatment not only induce fatigue like symp-
toms but also disrupt the circadian rhythm generated by the central
circadian pacemaker.
Disclosure: Nothing to disclose.
P138 | EEG changes during the transition from
slow-­wave sleep to wakefulness are associated
with melatonin and cortisol level
Y. Ukraintseva; K. Liaukovich
Human Higher Nervous Activity Lab, Institute of Higher Nervous
Activity and Neurophysiology of the Russian Academy of Sciences,
Moscow, Russian Federation
Objectives/Introduction: State change from slow-­
wave sleep
(SWS) to wakefulness proceeds gradually, not abruptly.
Electroencephalographic (EEG) phenomena preceding an awaken-
ing offer an opportunity to characterize the brain processes in-
volved in the transition from one vigilance state to another. We
aimed to correlate specific for this transition changes in EEG with
the time of the night and salivary melatonin and cortisol.
Methods: 11 healthy volunteers participated in an experimental
session with sound-­
induced short awakenings from SWS during
one 8 h night′s sleep (10–15 awakening per night). Salivary samples
were collected in the evening (at 23:00), in the night (at 01:30 and
04:00), and in the morning (at 07:00). We performed wavelet-­based
EEG processing to analyze cortical activity during the first 5 seconds
of the transition from SWS to wakefulness. We used nonparametric
statistics to compare EEG spectral power during sleep-­wake state-­
shifts occurred in the early night (EN -­from 23:00 to 01:30 h), middle
night (MN -­from 01:30 to 04:00 h), and late night (LN -­from 04:00
to 07:00 h) and to analyze associations between EEG activity and
hormones concentrations.
Results: SWS-­waking state-­shifts occurring during the MN were
accompanied by the strongest increase in the averaged across all
brain regions power of most EEG rhythms: delta (p = 0.012), theta
(p = 0.021), and alpha (p = 0.017). Additionally, there are significant
differences in the ratios of EEG spectral power in the anterior and
posterior areas of the cortex. So, during SWS-­wake transitions oc-
curred during EN and MN theta, alpha, and beta power prevailed in
the anterior regions, whereas in LN, it showed either uniform distri-
bution or prevalence in the posterior areas (p = 0.005, p = 0.008, and
p = 0.011 for theta, alpha, and beta, respectively). There are positive
correlations between salivary cortisol and prevalence of theta and
alpha power in posterior areas during state-­shifts, whereas salivary
melatonin was negatively associated with averaged theta, alpha, and
sigma power.
|
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Conclusions: These results suggest that patterns of cortical activ-
ity during the first seconds of the transition from SWS to waking
are heterogeneous, their spectral composition and cortical distribu-
tion are related to the time of the night and melatonin and cortisol
secretion.
Disclosure: This study was supported by the Russian Foundation for
Basic Research (RFBR grant № 18-­013-­01187 A).
P139 | The impact of sleep length on neural
processing of pleasant musical stimuli
R. Vasko1; H. Oginska2,3; A. Domagalik3; E. Beldzik 2,3; M.
Fafrowicz2,3; T. Marek 2,3
1
Institute of Zoology and Biomedical Research; 2Department of
Cognitive Neuroscience and Neuroergonomics, Institute of Applied
Psychology; 3Malopolska Centre of Biotechnology (MCB), Jagiellonian
University, Kraków, Poland
Objectives/Introduction: Pleasure and reward take a central place
in human life and the dysfunctions in brain reward system play a
pivotal role in many psychopathologies. However, less attention in
research is given to the relationships between sleep and emotional
neural mechanisms compared to cognitive aspects. Moreover, those
relationships have been studied mostly for negative emotions, so it
is compelling to explore also ‘the positive side’. In this study activa-
tions in response to musical stimuli of the brain areas involved in
pleasure processing were analysed in the context of sleep length and
chronotype.
Methods: 37 healthy young volunteers (mean age 24.1 ± 3.9 years;
24 females) took part in an fMRI experiment including the presen-
tation of ‘pleasant’ (individually matched) and ‘neutral’, 30-­sec mu-
sical fragments. The participants assessed subjective pleasure and
arousal for each given fragment on a 5-­point scale. The fMRI analysis
comprised first five seconds of each musical piece. We focused on
the activities of the medial orbitofrontal cortex (mOFC), anterior cin-
gulate cortex (ACC) and nucleus accumbens (NAc) as areas widely
considered to be involved in hedonic processing.
Self-­reported data on sleep habits were completed with actigra-
phy recordings obtained with AMI (Ambulatory Monitoring Inc.) or
MotionWatch8 (CamNtech Ltd) devices worn on a non-­dominant
wrist 24 h/7 days. Subjective circadian phase and amplitude were
assessed with the Chronotype Questionnaire. The Snaith-­Hamilton
Pleasure Scale was used to estimate hedonic tone.
Results: Subjective circadian characteristics, hedonic tone, and
self-­reported sleep times during last month did not show connec-
tions with activations of brain reward structures. The sleep index
(i.e. length of last night sleep relative to average last week, ‘habitual’
sleep) of the night preceding the MRI scanning was negatively as-
sociated with neural activity. That is, the shorter the sleep duration,
the higher activities in mOFC and ACC (p < 0.05) during listening of
‘pleasant’ fragments. No such relationship was observed for NAc.
 |
138 of 356       ABSTRACTS
Conclusions: Those results may be interpreted as a sign of height-
ened sensitivity of the pleasure processing system in state of sleep
shortening. This is consistent with the assumption that sleep depri-
vation leads to aberrant functioning of the reward system, increas-
ing the salience of positively-­reinforcing stimuli.
Disclosure: Nothing to disclose.
P140 | An EEG study on sleep homeostasis in a
songbird species, the European starling (Sturnus
vulgaris): REM sleep, why bother?
S.J. van Hasselt1; M. Rusche1,2; A.L. Vyssotski3; S. Verhulst1;
N.C. Rattenborg2; P. Meerlo1
1
Groningen Institute for Evolutionary Life Sciences, University of
2
Groningen, Groningen, The Netherlands; Avian Sleep Group, Max
Planck Institute for Ornithology, Seewiesen, Germany; 3Institute of
Neuroinformatics, University of Zurich, Zurich, Switzerland
Objectives/Introduction: Sleep is considered to be of crucial impor-
tance for optimal performance and health. However, most of what
we know about sleep is based on a handful of mammalian species
under laboratory conditions. Perhaps much can be learned from
comparative studies in other species. Birds are interesting in that
respect because they exhibit two sleep states that are similar to
mammalian rapid eye movement (REM) and non-­REM (NREM) sleep.
We therefore did a series of electro-­encephalogram (EEG) studies
in European starlings (Sturnus vulgaris) for a detailed assessment
of sleep architecture and sleep homeostasis under laboratory and
semi-­natural conditions.
Methods: We implanted 12 European starlings with epidural EEG
electrodes and applied miniature dataloggers to record their sleep-­
wake behavior. In the first experiment under controlled indoor
conditions, we measured baseline sleep and sleep homeostatic re-
sponses to 4 and 8-­hour sleep deprivations. In the second experi-
ment, we measured sleep under seminatural outdoor conditions
across the seasons.
Results: The birds showed a homeostatic NREM sleep response re-
flected in elevated EEG spectral power across a broad frequency
range and increased daytime napping. Starlings had hardly any REM
sleep (1.6% of total sleep time) and no REM sleep rebound after
sleep deprivation.
Under seminatural outdoor conditions, the birds showed extreme
variation in the amount of NREM sleep across the seasons with
5 hours more sleep in winter than in summer (12.5 h and 7.5 h re-
spectively, p < 0.001, n = 12). The daily sleep variation was best ex-
plained by photoperiod (p < 0.001, n = 12) and was also negatively
affected by moonlight (p < 0.001, n = 12). During long photoperiod,
starlings showed an increased sleep pressure that was reflected
in the slope of the decay of EEG spectral power during the nights
(p = 0.008, n = 12), resulting in an increase in daytime naps. Also,
under seminatural conditions starlings only displayed negligible
amounts of REM sleep.
Conclusions: This study confirms homeostatic regulation of NREM
sleep in songbirds. Yet, it also demonstrates high flexibility and
strong photoperiodic regulation of NREM sleep under natural condi-
tions. Finally, this study does not support an important role for REM
sleep.
Disclosure: Nothing to disclose.
P141 | Withings sleep apnea detector, a non-­
intrusive, unattended device, can be a substitute
to polygraphy to diagnose sleep apnea syndrome
P. Edouard1; D. Campo1; P. Bartet1; L. Marais1; M. Petitjean2;
G. Roisman2; M. Bruyneel3; P. Escourrou2
1
Withings, Issy-­les-­Moulineaux; 2Hôpital Antoine Béclère, Clamart,
France; 3Hôpital St-­Pierre, Bruxelles, Belgium
Objectives/Introduction: Polysomnography (PSG) is the gold stand-
ard to diagnose Sleep Apnea Syndrome (SAS). Polygraphy (PG) is an
ambulatory alternative. However, both methods are expensive and
intrusive with a reduced availability. Withings Sleep Apnea Detector
(WSAD) is a non-­intrusive pressure and sound sensor able to esti-
mate an Apnea Hypopnea Index (AHI). We aimed to compare the
efficiency of PG and WSAD against PSG.
Methods: 18 patients (67 F, 49 years, BMI 33 kg/m²) suspected of
SAS had an in-­laboratory PSG together with Withings Sleep Apnea
Detector. From the pressure signal, WSAD derives respiratory and
cardiac signals and movements. From the microphone, snoring and
snorting are detected. These features are used to detect sleep pe-
riods with a Random Forest classifier and AHI with a Convolutional
Neural Network (AHIwsad). From the PSG recordings, a double scor-
ing is performed according to AASM rules, first as a simple polyg-
raphy (AHIpg), then as a PSG (AHIpsg). Results of WSAD and PG are
compared against the gold standard. Bias, Mean Absolute Error
(MAE) and Root Mean Square Error (RMSE) were calculated, as
well as sensitivity, specificity, and the Area Under the ROC curve
(AUROC) for AHI thresholds 15 and 30 h−1.
Results: Average (SD) AHIpsg was 31.2 (25.0). For Withings Sleep Apnea
Detector, AHIwsad was 32.8 (29.9). The bias was 1.6, MAEwsad=9.5,
RMSEwsad=12.5. The sensitivity (Se15_wsad) and specificity (Sp15_wsad)
and their 95% confidence intervals were Se15_wsad=88.0% [79.0, 94.1]
and Sp15_wsad=88.6% [73.3, 96.8]. AUROC15_wsad=0.926. At the 30
threshold, Se30_wsad=86.0% [73.3, 94.2] and Sp30_wsad=91.2% [81.8,
96.7]. AUROC30_wsad=0.954. Alternatively, for Polygraphy, average
AHIpg was 21.4 (23.6). The bias was 9.9, MAEpg=11.3, RMSEpg=16.2.
The sensitivity (Se15_pg) and specificity (Sp15_pg) and their 95% con-
fidence intervals were Se15_pg=63.9% [52.6, 74.1] and Sp15_pg=97.1%
[85.1, 99.9]. AUROC15_pg=0.958. At the 30 threshold, Se30_pg=58.0%
[43.2, 71.8] and Sp30_pg=100.0% [94.7, 100.0]. AUROC30_pg=0.950.
ABSTRACTS
Conclusions: Diagnostic performance of PG and WSAD in terms of
AUROC are similar, but they operate at different points of their ROC
curves: Polygraphy underestimates AHI by an average 9.9 h−1, result-
ing in high specificities and low sensitivities, while WSAD has negli-
gible bias and balanced specificities and sensitivities.
Disclosure: Nothing to disclose.
P142 | Obstructive sleep apnea in people with
intellectual disabilities: compliance with and
effect of continuous positive airway pressure
N. van den Broek1; L. Broer2; N. Vandenbussche3; I. Tan4; S.
Overeem1,5; S. Pillen1,5
1 2
Centre for Sleep Medicine, Kempenhaeghe, Heeze; Faculty of Health,
Medicine and Life Science, Maastricht University, Maastricht; 3Centre
4 2
of Sleep Medicine, Kempenhaeghe, Heeze; Centre for Residential
5 3
Epilepsy Care, Kempenhaeghe, Sterksel; Department of Electrical
Engineering, University of Technology, Eindhoven, The Netherlands
Objectives/Introduction: Obstructive sleep apnea (OSA) is common
in people with intellectual disabilities (ID), with a reported preva-
lence up to 95% depending on age and underlying syndrome. This
high prevalence can be explained by anatomical abnormalities, co-
morbid obesity and hypotonia. OSA can have serious consequences
for quality of life, but treatment in people with ID has been investi-
gated scarcely. This study investigated compliance with and effect
of continuous positive airway pressure (CPAP) in patients with ID
and OSA.
Methods: CPAP was started using an intensive training program.
Good compliance was defined as use of ≥ 4 h/night during > 70% of
the nights. Treatment effect was measured with evaluation of apnea-­
hypopnea index (AHI) and customized questionnaires. Reasons for
not starting CPAP, factors influencing treatment, and reasons for
terminating CPAP were explored.
Results: We considered 88 patients diagnosed with OSA, 60 of
whom had an indication for CPAP. In 10 percent of these patients
CPAP was not started, as it was expected up front that it would
not be tolerated. 39 patients who started CPAP were included.
After 8–10 weeks and 8 months, respectively 87% and 70% still
used CPAP of whom 74% and 77% showed good compliance (re-
spectively 64% and 54% of the total patient group). Baseline AHI
decreased from 41.2/hour to 5.3/hour after 8–10 weeks, and 4.3/
hour after 8 months (p < 0.001). At 8–10 weeks there was a sig-
nificant improvement in the reported most restrictive complaint and
other complaints such as difficulty waking up, sleepiness, and ability
handling behaviour (p < 0.005). These improvements persisted after
8 months. CPAP use in the first two weeks predicted compliance at
8–10 weeks and 8 months (r = 0.51 p < 0.01 and r = 0.69 p < 0.01).
13 patients terminated CPAP. Reasons for termination were behav-
ioural problems, comorbid insomnia, anxiety, discomfort, side ef-
fects or reasons not related to CPAP.
|
      139 of 356
Conclusions: Physicians may be reluctant to refer patients with ID
for CPAP treatment, perhaps assuming a high chance of failure or
too high a burden compared to possible benefits. This study shows
that this reluctance is ungrounded, showing significant acceptance
of CPAP concurrent with improvements in several domains of daily
functioning.
Disclosure: Nothing to disclose.
P143 | Chronic insomnia in patients with
moderate or severe obstructive sleep apnea after
maxillomandibular advancement
R. Wix Ramos1,2,3; E. Rocio Martín1; E. Martín Abad1; A.
Capote 4; E. Zamora5; P. Landete5; P. Rubio-Bueno 4
1
Clinical Neurophysiology, University Hospital ‘La Princesa’;
Neurology, Universitary Hospital ‘HM Sanchinarro’, Sleep Unit, Madrid;
Neurology, Universitary Hospital ‘HM Puerta del Sur’, Sleep Unit,
Móstoles; 4Maxilofacial Department; 5Pnemulogy, University Hospital
‘La Princesa’, Madrid, Spain
Objectives/Introduction: Chronic insomnia and obstructive sleep
apnea and hypopnea syndrome (OSAS) are both common sleep dis-
orders. They predispose to the same long-­term, stress-­related ill-
nesses, and when they occur in the same individual, they interact
and each affects the other's response to treatment. The objective of
this study is to analyze the response of chronic insomnia in patients
with moderate or severe OSAS who underwent maxilomandibular
advancement (MMA) surgery as the primary treatment.
Methods: 30 consecutive patients of the sleep unit of the University
Hospital ‘La Princesa’. Who have undergone MMA surgery as pri-
mary treatment for OSAS. Diagnosed based by means of polysom-
nography (PSG) in a sleep laboratory. Semi-­structured interview,
and a sleep-­specific questionnaire. Scores on sleep-­questionnaires
[Epworth Sleepiness Scale (ESS); Insomnia Severity Index (ISI) to
evaluate its severity {no insomnia/subthreshold (0–14), moderate-­
severe (≥15)]; psychological tests [Beck depression inventory
(BDI-­II) {no-­mild  ≤  19, moderate-­severe (20–63)}; the state-­trait
anxiety inventory (STAI) considered positive above 50th percentile].
Patients were evaluated by preoperative and postoperative three-­
dimensional (3D) scans and polysomnograms.
Results: From our patients (26 M y 4 W) age between 15–63 years
old (40.8 ± 2.8).The Apnea-­Hypopnea Index (AHI) was 43.02 ± 4.9
per hour before surgery. Postoperative AHI was 8.5 ± 2.4 per hour
(p < 0.001). A total of 68% had insomnia before surgery. 23% sub-
clinical insomnia, the ‘moderate insomnia’ (27% prevalence) and
‘severe insomnia’ (18% prevalence) .The ‘asymptomatic’ group (32%
prevalence) had low insomnia. In the postoperative evaluation the
insomnia prevalence was 0% (p = 0.001). A significant reduction in
daytime sleepiness was observed, the ESS was 9.4 ± 1.1 and 3.3 ± 1.7
(p = 0.001). In terms of psychological tests, 13% of the cohort who
score for moderate-­severe depression. Anxiety state/trait was (23%
 |
140 of 356       ABSTRACTS
and 26%), no significant difference in assessment postoperative.
When comparing basal polysomnography, at the end of distraction
and once bimaxillary advance has been made no significant changes
in sleep architecture parameters were observed.
Conclusions: Chronic insomnia and OSAS share a pathophysiology
of chronic stress. Therefore, when chronic insomnia and OSAS occur
in one individual, aggressive treatment of OSAS may lead to a reduc-
tion in chronic stress that causes the patient's chronic insomnia to
remit.
Disclosure: Nothing to disclose.
P144 | A positive treatment effect of cervical
collar in moderate obstructive sleep apnea – a
pilot study
F. Delijaj1,2
1
Department of Public Health and Caring Sciences, Uppsala University,
Uppsala; 2Center for Clinical Research CKF, Region Sörmland,
Eskilstuna, Sweden
Objectives/Introduction: An optimal stabilization and mild retro
flexion of the neck with a cervical collar (CC) could possibly re-
duce obstruction of the upper airways in patients with moder-
ate Obstructive Sleep Apnea (OSA). The primary objectives in this
randomized, open, parallel-­group intervention pilot study was to
compare the effects on OSA of cervical collar and lifestyle advice
combination therapy with effects of lifestyle advice alone. The ef-
fect was assessed by changes of Apnea – Hypopnea Index (AHI).
Methods: Consecutive subjects (n = 17) with moderate OSA accord-
ing to baseline Nocturnal Respiratory Registration (NRR) were ran-
domized to either group 1 or 2. Subjects in group 1 (n = 8) received
instructions and advice on lifestyle according to current clinical prac-
tice while subjects in group 2 (n = 9) received the same instructions
and advice as in group 1 and also got a CC and instructions on how to
use it during sleep. Another NRR was performed in all subjects after
6 ± 2 weeks of treatment. Subjects filled in questionnaires before
and after treatment. Questionnaires included questions about life-
style and sleep disturbances including relevant daytime symptoms.
Questionnaire 2 also included reporting of side effects. In the statis-
tical analysis we used the paired T-­test to test the hypothesis of no
difference between baseline and follow up.
Results: The baseline AHI for group 1 was 19. 8 and changed to 20. 2
at follow-­up (p = 1). The baseline AHI for group 2 was 22. 8 decreas-
ing to 13.0 at follow up (p < 0.05).
Conclusions: The pilot study showed a significant reduction in AHI
through life style advice in combination with CC. These preliminary
results are promising and we are therefore planning a larger study.
Disclosure: Nothing to disclose.
P145 | Diagnosis of sleep apnea without
sensors on the patient′s face
A. Sabil1,2; C. Marien3; M. Le Vaillant4; G. Baffet5; N.
Meslier3,6; F. Gagnadoux3,6
1
Cloud Sleep Lab; 2Clinical Research, Philips SRC, Paris; 3Département
de Pneumologie, Centre Hospitalier Universitaire d'Angers, Angers;
4
Institut de Recherche en Santé Respiratoire des Pays de la Loire,
Beaucouzé; 5Recherche et Développement, CIDELEC; 6Inserm UMR
1063, Université d'Angers, Angers, France
Objectives/Introduction: Thermistors, nasal cannulas and respira-
tory inductance plethysmography (RIP) are the reference sensors
(AASM recommendations) for the detection and characterization of
apneas and hypopneas. However, these sensors are not well toler-
ated by patients and have a poor scorability. We evaluated the per-
formance of an alternative method using a combination of tracheal
sounds and RIP signals.
Methods: Recordings of 70 adult patients from the Pays de la Loire
Sleep Cohort were manually scored in a random order using the
AASM standard signals and the combination tracheal sound (TS) and
RIP signals, TS-­RIP, without respiratory sensors placed on the pa-
tient's face. The TS-­RIP scoring used the TS and RIP-­Flow signals for
detection of apneas and hypopneas respectively, and the supraster-
nal pressure (SSP) and RIP belts signals for the characterization of
apneas.
Results: Sensitivity (Se) and specificity (Sp) of the TS-­RIP combina-
tion were 96.21% and 91.34% for apnea detection, and 89.94% and
93.25% for detecting hypopneas, respectively, with a Kappa coef-
ficient of 0.87. For the characterization of apneas, Se and Sp were
98.67% and 96.17% for obstructive apneas, 92.66% and 99.36% for
mixed apneas, and 96.14% and 98.89% for central apneas, respec-
tively, with a Kappa coefficient of 0.94. The TS-­RIP scoring revealed
a high agreement for classifying obstructive sleep apnea (OSA) into
severity classes (no OSA, mild, moderate and severe OSA) with a
Cohen′s Kappa coefficient of 0.96.
Conclusions: Compared to the AASM reference, the TS-­RIP com-
bination allows reliable non-­invasive detection and characterization
of respiratory events with a high degree of sensitivity and specific-
ity. TS-­RIP combination could be used for OSA diagnosis, in adults,
either as an alternative or in combination with the recommended
AASM sensors.
Disclosure: At the time of the study, both A SABIL and G Baffet were
working for CIDELEC.
ABSTRACTS
P146 | JZP-­258 dose titration and transition
from sodium oxybate in a placebo-­controlled,
double-­blind, randomised withdrawal study in
adult participants with narcolepsy with cataplexy
Y. Dauvilliers1,2; N. Foldvary-Schaefer3; R.K. Bogan4; L.
Huang5; R. Skowronski5; M.J. Thorpy6
1
Sleep and Wake Disorders Centre, Department of Neurology, Gui
de Chauliac Hospital; 2University of Montpellier, INSERM U1061,
Montpellier, France; 3Cleveland Clinic Lerner College of Medicine,
Cleveland, OH; 4University of South Carolina School of Medicine,
Columbia, SC; 5Jazz Pharmaceuticals, Inc., Palo Alto, CA; 6Albert
Einstein College of Medicine, Bronx, NY, United States
Objectives/Introduction: Sodium oxybate (SXB) is a standard of care
for the treatment of cataplexy and excessive daytime sleepiness in
narcolepsy. JZP-­258 is an oxybate product candidate (at same con-
centration as SXB) with 92% less sodium. Efficacy of JZP-­258 was
established in a placebo-­controlled, double-­blind, randomised with-
drawal study. JZP-­258 dose adjustment during titration was evalu-
ated in this study.
Methods: At study entry, participants were taking SXB only,
SXB+other anticataplectics, anticataplectics other than SXB, or
were cataplexy treatment naive. JZP-­258 treatment began during
a 12-­
week, open-­
label optimised treatment and titration period.
Participants taking SXB only or SXB+other anticataplectics tran-
sitioned to JZP-­258 at the same gram-­for-­gram dose as SXB and
titrated to an efficacious and tolerable (optimal) dose from weeks
3–12. Participants taking other anticataplectics or who were anti-
cataplectic naive initiated JZP-­258 at 4.5 g/night and were titrated
to an optimal dose at a rate of 1–1.5 g/night/week (maximum total
dose, 9 g/night). A 2-­week stable-­dose period and 2-­week, double-­
blind, randomised withdrawal period followed.
Results: During the stable-­dose period, total nightly JZP-­258 dose
(median [range]) was higher in participants taking SXB at study entry
(SXB-­only, 7.5 g [4.5–9.0], n = 45; SXB+other anticataplectics, 9.0 g
[6.0–9.0], n = 14) compared with those not taking SXB (other an-
ticataplectics, 7.5  g [4.5–9.0], n = 23; anticataplectic-­naive, 7.0 g
[3.0–9.0], n = 67), and dose adjustments were fewer. In most (69%)
participants taking SXB at study entry who entered the stable-­dose
period, no change in dose was required (median [range] number of
adjustments was 0 ([0–8]); for those with a change in dose, most
changes were within one titration step (1.5 g/night). In participants
not taking SXB at study entry, the median (range) number of adjust-
ments was 3.0 (0–7).
Conclusions: Most participants taking SXB at study entry transi-
tioned to JZP-­258 treatment at the same dose with retained effec-
tiveness. Participants not previously taking SXB achieved a tolerable
and efficacious dose of JZP-­258 after a median of 3 adjustments.
Disclosure: Support: Jazz Pharmaceuticals. Y Dauvilliers is a
consultant for and has participated in advisory boards for Jazz
Pharmaceuticals, UCB Pharma, Flamel Technologies, Theranexus,
|
      141 of 356
and Bioprojet. N Foldvary-­Schaefer has served on an advisory com-
mittee for Jazz Pharmaceuticals and participated in clinical trials
supported by Jazz Pharmaceuticals, Suven, and Takeda. RK Bogan
has served on the speakers’ bureau and participated in advisory
boards for Jazz Pharmaceuticals. L Huang and R Skowronski are
full-­time employees of Jazz Pharmaceuticals who, in the course of
this employment, have received stock options exercisable for, and
other stock awards of, ordinary shares of Jazz Pharmaceuticals, plc.
MJ Thorpy has received research/grant support and consultancy
fees from Jazz Pharmaceuticals, Harmony Biosciences, Balance
Therapeutics, Axsome Therapeutics, and Avadel Pharmaceuticals.
P147 | Narcolepsy type 1 features through
the lifetime: age impact on clinical and
polysomnographic phenotype
A. Lividini1; F. Pizza2,3; M. Filardi2; S. Vandi2,3; F. Ingravallo1;
E. Antelmi4; O. Bruni5; F.I.I. Cosentino6; R. Ferri6; B.
Guarnieri7; S. Marelli8; L. Ferini-Strambi8; A. Romigi9; E.
Bonanni10; M. Maestri10; M. Terzaghi11,12; R. Manni11; G.
Plazzi2,3
1
Department of Medical and Surgical Sciences, University of Bologna;
2
Department of Biomedical and Neuromotor Sciences DIBINEM,
University of Bologna; 3IRCCS, Istituto delle Scienze Neurologiche
di Bologna, Bologna, Italy., Bologna; 4Neurology Unit, Movement
Disorders Division, Department of Neurosciences, Biomedicine and
Movement Sciences, University of Verona, Verona; 5Department of
Developmental and Social Psychology, Sapienza University of Rome,
Rome; 6Sleep Research Center, Department of Neurology IC, Oasi
Research Institute – IRCCS, Troina; 7Center of Sleep Medicine, Dept.
Neurology Villa Serena Hospital, Città S. Angelo, Pescara; 8Department
of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute,
Neurology – Sleep Disorders Centre, Milan; 9IRCCS Neuromed Istituto
Neurologico Mediterraneo Sleep Medicine Centre Pozzilli, Pozzilli;
10
Department of Clinical and Experimental Medicine, Neurology Unit,
11
University of Pisa, Pisa; Unit of Sleep Medicine and Epilepsy, IRCCS
12
Mondino Foundation; Department of Brain and Behavioral Sciences,
University of Pavia, Pavia, Italy
Objectives/Introduction: Narcolepsy type 1 (NT1) is a chronic neu-
rological disorder typically arising during adolescence and young
adulthood. Recent studies demonstrated that NT1 presents with age
specific features, especially in children. With this study we aimed
to describe and to compare the clinical pictures of NT1 in different
ages groups.
Methods: In this cross-­sectional, multicentre study, 106 consecu-
tive untreated NT1 patients were enrolled at the time of diagno-
sis and underwent clinical evaluation, a semi structured interview
(including the Epworth Sleepiness Scale – ESS), nocturnal video-­
polysomnography and the multiple sleep latency test (MSLT).
 |
142 of 356       ABSTRACTS
Patients were divided into five age groups (childhood, adolescence,
adulthood, middle-­aged and seniors).
Results: The ESS score showed a significant increase with age,
while self-­reported diurnal total sleep time was lower in elderlies
and young adults, with the latter also complaining automatic behav-
iors in more than 90% of cases. Children presented more frequent
cataplexy attacks (>1/day in 95% of cases). ‘Recalling an emotional
event’, ‘meeting someone unexpectedly’, ‘stress’ and ‘anger’ were
triggers more frequently reported in adult and elderly patients.
Neurophysiological data showed a higher number of SOREMPs
at MSLT in adolescents compared to senior patients, and an age-­
progressive decline in sleep efficiency was observed.
Conclusions: Daytime sleepiness, cataplexy features and triggers
and nocturnal sleep structure showed age-­
related difference in
NT1 patients; this variability may contribute to diagnostic delay and
misdiagnosis.
Disclosure: Nothing to disclose.
P148 | Response to pitolisant therapy in
patients with difficult to treat hypersomnia
J.S. Kaler1; E. Lyons1; V. Gnoni1; L. Perez-Carbonell1; S.
Higgins1; R. Muza1; P. Drakatos1,2; G.D. Leschziner1,3; G.
d'Ancona1; B.D. Kent1,4,5
1
Sleep Disorders, Guy's and St Thomas’ NHS Foundation Trust;
2
Faculty of Life Sciences and Medicine; 3Department of Basic and
Clinical Neurosciences, IoPPN, King's College London, London, United
Kingdom; 4National Narcolepsy Centre, St James’ Hospital; 5School of
Medicine, Trinity College, Dublin, Ireland
Objectives/Introduction: Limited treatment options are available
for patients with central hypersomnia, and many patients continue
to have significant symptoms of excessive daytime sleepiness (EDS)
despite use of established therapies. Little is known about the util-
ity of pitolisant therapy in patients whose symptoms are refractory
to conventional stimulant therapy. We assessed outcomes in hyper-
somnia patients who were resistant to or intolerant of conventional
therapy.
Methods: Patients with objectively confirmed central hypersomnia,
who had persistent EDS despite use of ≥ 2 wakefulness promoting
agents, were commenced on pitolisant via a pharmacist-­led clinic.
We prospectively recorded the Epworth Sleepiness Scale (ESS),
Pittsburgh Sleep Quality Index (PSQI), and quality of life scores (EQ-­
5D visual analogue scale) at initiation and after 12 weeks of pitolisant
therapy. We defined response as a reduction in ESS of ≥ 2.
Results: A total of 68 patients were given pitolisant (age
38.6 ± 14.9 years; 56% female; 72% NT1). Ten stopped treatment
early due to adverse effects (30% sleep fragmentation; 20% head-
ache; 20% allergic reaction). Among those who completed 12 weeks
of therapy, ESS reduced from 17.4 ± 4.7 to 14.5 ± 5.2 (p < 0.001),
PSQI reduced from 10.1 ± 3.6 to 8.2 ± 4.5 (p < 0.001), and EQ-­5D
improved from 55.8 ± 18.5 to 65.6 ± 18.4 (p < 0.001). 37 patients had
baseline cataplexy: following initiation of pitolisant 13% had cessa-
tion of cataplexy; 21% had reduced symptoms. Median modafinil
dose reduced from 500 mg (IQR: 375–600 mg) to 400 mg (IQR:
200–600 mg) at pitolisant target dose (p = 0.004); methylphenidate
dose reduced from 36 mg (IQR: 20–54 mg) to 20 mg (IQR: 0–36 mg)
(p < 0.001); dexamfetamine dose reduced from 40 mg (IQR:
30–44 mg) to 32 mg (IQR: 7–40 mg) (p = 0.018). 36 patients (53%)
were responders: compared with non-­responders, responders were
younger (age 34.9 ± 14.1 years Vs 43.5 ± 15.3 years (p = 0.034)),and
at baseline had more hallucinations (47% Vs 19%, p = 0.004), less
sleep paralysis (25% Vs 38%, p = 0.002), less cataplexy (50% Vs 71%,
p = 0.029), less dexamfetamine usage (22%Vs 38%, p = 0.002) and
less sodium oxybate usage (22% Vs 38%, p = 0.0015).
Conclusions: In a cohort of patients with difficult to treat central
hypersomnia, daytime sleepiness and quality of life scores improved
following initiation of pitolisant. There was also significant improve-
ment in sleep quality, and a reduction of concomitant stimulant
therapy usage. Pitolisant may be a useful adjuvant therapy in some
patients with treatment refractory hypersomnia.
Disclosure: Nothing to disclose.
P149 | New 2013 incidence peak in childhood
narcolepsy: more than vaccination?
Z. Zhang1; J. Gool2; R. Fronczek 2; G.J. Lammers2; R.
Khatami1; European Narcolepsy Network
1
Center for Sleep Medicine, Sleep Research and Epileptology, Klinik
Barmelweid AG, Barmelweid, Switzerland; 2Department of Neurology
and Clinical Neurophysiology, Leiden University Medical Center, Leiden,
The Netherlands
Objectives/Introduction: Increased incidence rates of narcolepsy
type-­1 (NT1) have been reported world-­wide after the 2009–2010
H1N1 influenza pandemic (pH1N1). While some European countries
found an association between the NT1 increase and H1N1 vacci-
nation with Pandemrix, reports from Asian countries suggested the
H1N1 virus rather than Pandemrix to be linked with the increase of
new NT1 cases.
Methods: We analyzed the number of de-­novo NT1 cases (n = 508)
between 1995–2016 using the European Narcolepsy Network da-
tabase. We chose the year of excessive daytime sleepiness onset as
disease onset. Using locally estimated scatterplot smoothing meth-
ods and the numbers of NT1 patients before and after 2009–2010
pH1N1, we predicted the number of cases and their 95% predictive
confidence intervals (95%-­CI) in 2009–2011. The ratios between the
real and the predicted numbers of patients and their 95%-­CI were
calculated. The incidence of NT1 was considered as significantly in-
creased if the 95%-­CI of the ratio was larger than one. The same
analyses were also done in the subgroups of childhood NT1 (n = 256)
and adulthood NT1 (n = 252), and in each country (France, Finland,
ABSTRACTS
Germany, The Netherlands, Czech Republic, Italy and Switzerland),
respectively.
Results: We confirmed the peak of NT1 incidence in 2010, i.e.,
2.54-­fold (95%-­CI: [2.11, 3.19]) increase in NT1 onset following
2009–2010 pH1N1. This 2010 peak was found in both childhood
NT1 (2.75-­fold increase, 95%-­CI: [1.95, 4.69]) and adulthood NT1
(2.43-­fold increase, 95%-­CI: [2.05, 2.97]). In addition, we identified a
new peak in 2013 that is age-­specific for children/adolescents (i.e.,
2.09-­fold increase, 95%-­CI: [1.52, 3.32]). This new peak in childhood
NT1 were found in Italy (2.18-­fold increase, 95%-­CI: [1.39, 5.05]),
the Netherlands (2.80-­fold increase, 95%-­CI: [1.80, 6.39]), France
(2.47-­fold increase, 95%-­CI: [1.54, 6.15]) and Switzerland (2.84-­fold
increase, 95%-­CI: [1.54, 17.89]), but not in other countries. Most
of these de-­novo childhood cases (64% patients) showed a suba-
cute disease onset consistent with an immune-­mediated type of
narcolepsy.
Conclusions: This new 2013 peak is likely not related to Pandemrix
as it was not used after 2010. Our findings provide a unique oppor-
tunity to develop new hypotheses, e.g., considering other (influenza)
viruses or epidemiological events to further investigate the patho-
physiology of immune-­mediated narcolepsy.
Disclosure: Nothing to disclose.
P150 | Is it more about mood than about sleep?
An investigation into moderators and mediators
of treatment response to cognitive behavioural
therapy for insomnia
C. Sandlund 1,2 3,4
; A. Norell-Clarke
1
Academic Primary Health Care Centre, Stockholm Region, Stockholm;
2
Karolinska Institutet, Huddinge; 3Karlstad University, Karlstad;
4
Kristianstad University, Kristianstad, Sweden
Objectives/Introduction: Cognitive behavioural therapy for insom-
nia (CBT-­I) is the first-­line treatment for insomnia. Although 80%
improve, 50% do not reach full remission. This study aimed to inves-
tigate the characteristics of patients who continue to report insom-
nia after CBT-­I.
Methods: Secondary analyses of a randomized controlled trial in
Swedish primary care that included 165 patients with insomnia dis-
order. The intervention was seven sessions of nurse-­administrated
CBT-­I as group treatment over ten weeks. The control condition
was treatment as usual. Remission from insomnia was assessed by
the yes-­or-­no question ‘Would you say that you have insomnia?’ at
post-­treatment.
Results: At post-­treatment, insomnia was reported by 95% in the
control group (56 of 59), and by 57% in the intervention group (41
of 72). Patients who still reported insomnia after CBT-­I had poorer
mental health at baseline than those reporting remission (depres-
sive symptoms, p = 0.006; psychological distress, p = 0.026; mental
functioning, p = 0.048). They improved similarly to those reporting
|
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remission in sleep onset latency, time awake after sleep onset, sleep
duration, sleep efficiency, awakenings, and sleep quality (p  >  0.1,
respectively), fatigue, psychological distress, depressive symptoms,
and mental functioning (p  >  0.2, respectively). They improved less
in insomnia severity (p  =  0.001), dysfunctional beliefs about sleep
(p < 0.001), and use of hypnotics (p = 0.014). Change in depressive
symptoms during treatments mediated between CBT-­I and remis-
sion of insomnia in a model that took depressive symptoms and in-
somnia severity at baseline into account (direct effect, b = −2.58, CI
−3.99, −1.16; indirect effect, b = −1.64, CI −3.38, −0.81). Depressive
symptoms at baseline (-­b = 0.32, p < 0.001) was a significant predic-
tor of remission, but insomnia severity was not (-­b = 0.08, p = 0.265).
Conclusions: Although CBT-­I improved sleep and daytime symp-
toms, the degree of depressive symptoms prior to treatment, as
well as change in depressive symptoms during treatment, affected
whether patients reported that they still suffered from insomnia or
not. These findings highlight the importance of careful assessment
of patients with insomnia in primary care and suggest tailored treat-
ment for patients with pronounced depressive symptoms.
Disclosure: Nothing to disclose.
P151 | Slow oscillation-­spindle coupling
strength relates to overnight gross-­motor
learning
M.A. Hahn1; K. Bothe1; R.F. Helfrich2; K. Hödlmoser1
1
Department of Psychology, Univeristy of Salzburg, Salzburg, Austria;
2
Hertie-­Institute for Clinical Brain Research, University of Tübingen,
Tübingen, Germany
Objectives/Introduction: The active role of sleep for fine-­motor
learning is well established even though results tend to differ across
age groups. Critically, little is known about sleep-­related consolida-
tion of gross-­motor learning, which is essential for everyday life.
One key mechanism of memory consolidation during sleep is slow-­
oscillation spindle coupling. While this mechanism is frequently
related to declarative memory, it is unclear whether slow oscillation-­
spindle coupling constitutes a model for gross motor skill consoli-
dation. Here, we assessed gross-­motor learning (juggling) in adults
and adolescents and investigated whether slow oscillation-­spindle
coupling relates to overnight juggling changes.
Methods: Adults (N = 25; age = 19–29; 15 male) and adolescents
(N = 20; age = 12–15; 19 male) were randomly assigned into a sleep
and a wake group. Participants in the sleep group performed the jug-
gling training in the evening. Juggling was tested before and after
a full night of sleep with polysomnography recordings. Participants
in the wake group trained in the morning and their juggling perfor-
mance was assessed before and after a wake retention interval. To
compute slow oscillation spindle coupling parameters, we adopted
an individualized cross-­frequency coupling approach.
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144 of 356       ABSTRACTS
Results: Juggling performance of adults was stabilised across sleep
but declined across wakefulness, whereas juggling performance of
adolescents was stabilised across wakefulness but declined across
sleep (F(1,41) = 4.764, p = 0.035, p.eta² = 0.103). Collapsed across
both age groups, slow oscillation-­spindle coupling strength posi-
tively related to the overnight juggling performance change (rhos =
0.58, p = 0.006), indicating that participants with more precise cou-
pling showed better overnight performance stabilisation.
Conclusions: Our results suggest that sleep consolidates gross-­
motor performance (juggling) in adults but not in adolescents.
Importantly, precise memory network coordination during sleep
reflected by slow oscillation-­spindle coupling could support the con-
solidation of gross-­motor performance.
Disclosure: Nothing to disclose.
P152 | Sleep preferentially promotes learning
of egocentric and intrinsic spatial reference
systems in a visuospatial task
1 1 1 1 1 Austria; 3Centre for Human Brain Health, University of Birmingham,
B. Albinni ; F. Conte ; O. De Rosa ; M. Luongo ; M. Maiello ;
S. Malloggi2; B. Pizzo1; F. Giganti2; G. Ruggiero1; G. Ficca1
1 Hospital of the University of Basel; 5Transfaculty Research Platform
Department of Psychology, University of Campania – Luigi Vanvitelli,
Caserta; 2Department NEUROFARBA, University of Florence, Firenze,
Italy
Objectives/Introduction: Compared to other types of memory,
spatial memory has received minor attention in sleep-­memory re-
search. The role of sleep in spatial learning has been mainly explored
through motor tasks, which do not allow to clearly single out purely
spatial components of performance from the motor ones. Also, the
possible differential contribution of sleep to the consolidation of
learning in the different spatial reference systems (SRSs) (egocentric,
allocentric, intrinsic) is still unclear.
Here, we investigate the effect of sleep vs. wake on the consolidation
of visuospatial learning through a Judgment of Relative Direction
Task (JRD), which minimizes the involvement of motor responses and
allows a separate assessment of SRSs.
Methods: Two groups of healthy adults were administered the JRD
before and after an 8 hrs retention period spent awake (WAKE,
N = 7) or asleep (SLEEP, N = 7). In the task, subjects learn a 7-­letter
layout on the floor followed by a computerized test phase consisting
of 48 trials (e.g., ‘You are standing on A and facing G: where is C?’)
divided in 3 blocks (1 for each SRS), administered in balanced order
between subjects. Dependent variables were speed (seconds) and
accuracy (angular difference, in degrees, between the given and the
correct answer).
Results: Mixed rmANOVA showed a main effect of TIME (immediate
vs, delayed recall) on accuracy only in the egocentric (F = 14.444,
p = 0.003) and intrinsic (F = 13.437, p = 0.003) SRSs, while speed
increased over TIME in all 3 SRSs (egocentric: F = 9.476, p = 0.01;
allocentric: F = 13.522, p = 0.003; intrinsic: F = 11.257, p = 0.006).
No main effect of GROUP was observed for either measure in either
of the SRSs whereas an interaction effect was found only for speed,
with a greater improvement of the SLEEP group in the egocentric
(F = 8.854, p = 0.012) and intrinsic (F = 4.986, p = 0.045) SRSs.
Conclusions: Using a visuospatial task aimed at minimizing motor
processing involvement, we found that sleep preferentially pro-
motes learning in the egocentric perspective, at variance with previ-
ous data showing sleep benefits on allocentric components in motor
tasks. Moreover, this is the first evidence of a sleep effect on the in-
trinsic component of spatial memory: the cognitive and neurophysi-
ological processes underlying this effect remain to be ascertained.
Disclosure: Nothing to disclose.
P153 | System of brain rhythms during sleep
M. Wislowska1,2; W. Klimesch1; O. Jensen3; C. Blume 4,5; M.
Schabus1,2
1
Centre for Cognitive Neuroscience; 2Laboratory for Sleep, Cognition
and Consciousness Research, Univeristy of Salzburg, Salzburg,
Birmingham, United Kingdom; 4Centre for Chronobiology, Psychiatric
Molecular and Cognitive Neuroscience, University of Basel, Basel,
Switzerland
Objectives/Introduction: Almost a century has passed since the leg-
endary first recording of the brain alpha rhythm. The following nu-
merous investigations of Hans Berger and other scientists brought us
closer to understanding the fascinating association between oscilla-
tory and cognitive systems. However, neural dynamics during sleep
are very distinct from those observed during wakefulness. As we fall
asleep, alpha waves fade out, whereas sleep spindles and slow oscil-
lation become prevalent, to name a few examples. Nevertheless, the
sleeping brain maintains various forms of information processing de-
spite the decrease of arousal and altered oscillatory dynamic. In the
current project, we strive to understand how the interplay between
oscillatory and cognitive systems is implemented during sleep. For
this purpose, we investigated temporal organization of brain re-
sponses to acoustic stimuli presented across wakefulness and sleep.
Methods: We invited 27 young and healthy participants
(25 ± 2.4 years old; 16 females) to our MEG laboratory. After
20 min of wakefulness, the subjects were given a 2 h sleep oppor-
tunity. Auditory stimuli (first names) were presented via earphones
throughout the entire experiment, while ongoing brain activity was
simultaneously recorded with EEG and MEG.
Results: Presentation of auditory stimuli induced a cascade of brain
responses that were composed of specific oscillatory components.
Interestingly, this temporal profile changed across wakefulness and
sleep. An early ERP component (60–90 ms post stimulus) was gener-
ated by theta in wakefulness, and by phase-­aligned alpha and sigma
during all sleep stages. Similarly, inter-­trial phase locking of the sigma
ABSTRACTS
frequency band became evident only during (deep) sleep. The analy-
sis of transient phase-­to-­phase cross-­frequency coupling (analyzed
with CI = 99.99% and α=0.05%) revealed that in wakefulness lower
alpha and theta aligned in phase within the first ~300 ms, and beta-­
gamma phase synchronized within the first ~100 ms. In the light
sleep stages (N1 and N2), a similar theta-­alpha phase coupling could
be observed, whereas beta-­gamma phase alignment disappeared
after falling asleep.
Conclusions: The organization of frequencies suggests an active in-
terplay between episodic, acoustic, and perhaps even semantic pro-
cessing of the environmental information during wakefulness. This
system seems to be to some extend preserved, yet differently initi-
ated and organized, during light and deep sleep.
Disclosure: Nothing to disclose.
P154 | Slow wave sleep has no homeostatic
effect on fear extinction learning
E. Friesen; M.R. Sopp; A.H. Brueckner; T. Michael
Clinical Psychology and Psychotherapy, Saarland University,
Saarbruecken, Germany
Objectives/Introduction: Trauma-­focused psychotherapy for post-
traumatic stress disorder (PTSD) involves the reprocessing of trau-
matic memories, which is assumed to result in extinction learning.
Research has demonstrated that sleep disturbances can impede such
learning processes, which may result in poor therapeutic outcomes.
However, the underlying mechanisms remain unclear. According to
the synaptic homeostasis hypothesis (Tononi and Cirelli, 2014), sleep
facilitates encoding by promoting synaptic renormalization during
slow wave sleep (SWS). Based on this hypothesis, we tested whether
SWS-­rich sleep prior to fear extinction training increases the effec-
tiveness of extinction learning.
Methods: We used a partial sleep deprivation design and a differ-
ential fear conditioning paradigm, modified to examine fear learn-
ing in PTSD. In the acquisition phase, a neutral face (conditioned
stimulus) was paired with the presentation of aversive film clips (un-
conditioned stimulus) while another neutral face (control stimulus)
was followed by neutral film clips. On the next evening, participants
were divided into two experimental groups. One group received a
3-­hour sleep opportunity, whereas the other group stayed awake.
Thereafter, both groups underwent extinction training and a return-­
of-­fear test. Extinction recall was re-­assessed after another sleep
opportunity in both groups. Sleep was measured by means of poly-
somnographic recordings in the laboratory. Effects were considered
significant at p < 0.05.
Results: 61 participants took part in the experiment. Linear mixed
models showed no significant effects of sleep manipulation on sub-
jective fear expressions and skin conductance responses during
extinction training and extinction recall. The sleep group showed
|
      145 of 356
increased skin conductance responses in the early return-­of-­fear
test for both stimuli.
Conclusions: Sleep-­induced synaptic homeostasis was found to en-
hance memory encoding in previous studies. By contrast, the current
study does not support the hypothesis of strengthened fear extinc-
tion by prior SWS. Models focusing on the role of rapid eye move-
ment (REM) sleep – rather than SWS – in synaptic renormalization
might be important to consider. Further research should investigate
these putative processes and their implications for the treatment of
PTSD.
Disclosure: This study was funded by the German Research
Foundation (SO 1716/1-­1).
P155 | Associations between gut microbiota
and sleep quality in older adults with insomnia:
distinctions between short and normal sleep
duration
I. Haimov1; K. Asraf2; F. Mazgal3; M. Agmon4; S. Tamir3; T.
Shochat4
1
Yezreel Academic College, Yezreel Academic College, Alon Hagalil,
France; 2Yezreel Academic College, Yezreel Academic College, Emek
Yezreel; 3Laboratory of Human Health and Nutrition Sciences, MIGAL-­
Galilee Research Institute, Kiryat Shmona; 4University of Haifa, Haifa,
Israel
Objectives/Introduction: Insomnia is a chronic disorder of hypera-
rousal, associated with negative health and functional outcomes.
Growing evidence suggests that insomnia with short sleep duration
constitutes the most severe and biologically based phenotype; how-
ever, underlying mechanisms are unclear. The ability of gut micro-
biota to communicate with the brain is an exciting concept, yet few
have investigated its involvement in sleep. We tested associations
between gut microbiota composition and sleep quality among older
adults with insomnia, and compared short and normal sleep duration
phenotypes.
Methods: Sixty-­
t wo older adults with insomnia (mean age
73.4 ± 5.61 years, 46 females) provided a stool sample for gut mi-
crobial sequencing. Microbiota profile was determined using the
Qiime2 bioinformatics pipeline. Sleep was monitored over two
weeks by wrist-­worn actigraphy. Sleep measurements included total
sleep time (TST), sleep latency (SL), sleep efficiency (SE), and wake
after sleep onset (WASO). Participants completed the Insomnia
Severity Index (ISI). Spearman correlations were used to correlate
sleep measures and microbiota composition. Using cluster testing,
participants were divided to short (5:41 ± 0:40, n = 22) and normal
(7:19 ± 0:38, n = 40) sleep duration phenotypes.
Results: Normal and short sleep duration phenotypes groups did not
differ in age, BMI, education, or sex distribution. In the combined
sample, at the genus level, shorter SL was correlated with higher
abundances of Clostridium (Lachnospiraceae) (rs=-­.32, p = 0.009),
 |
146 of 356       ABSTRACTS
Ruminococcus (rs=-­.34, p = 0.007) and Gemmiger (rs=-­.34, p = 0.006),
and increased SE was correlated with higher abundances of Blautia
(rs=.37, p = 0.003) and Clostridium (Lachnospiraceae) (rs=.39, p = 0.007).
In the normal sleep duration group, higher ISI was correlated with
higher abundance of Odoribacter (rs=.46, p = 0.003); whereas in the
short sleep duration group, shorter SL and increased SE were corre-
lated with increased abundances of Barnesiella (rs = -­.53, p = 0.009)
and Blautia (rs=.54, p = 0.009), respectively.
Conclusions: Findings demonstrate associations between sleep
quality and gut microbiota composition among older adults with
insomnia with short and normal sleep duration. Findings are par-
tially supported by the literature (e.g., higher levels of Clostridium
(Lachnospiraceae), have been previously associated with better sleep
quality). Further studies are needed to validate findings and deter-
mine whether improving microbiome composition via dietary inter-
vention may improve sleep quality among older adults.
Disclosure: Nothing to disclose.
P156 | Cold habituation and modification in
sleep and electroencephalogram in rats
O. Shylo; O. Petrova; V. Lomako; G. Babijchuk
Cryophysiology, Institute for Problems of Cryobiology and Cryomedicine
of the National Academy of Sciences of Ukraine, Kharkiv, Ukraine
Objectives/Introduction: Habituation is the most common response
of the body to repeated stimulations. As a part of the normal ther-
moregulatory response, contact with the cold environment causes
skin vasoconstriction and delays the sleep onset. But what happens
to sleep and EEG during the habituation, when the initial reaction to
the cold is blunted, has been poorly investigated. The research aim
was to study modifications in sleep structure and EEG induced by
cold habituation.
Methods: White outbred rats (male, 250–300 g, n = 6) were rhyth-
mically cold exposed (5°C, airflow velocity 6.5 m/s) over two days
in the light period for 15 min hourly (nine exposures per day).
Continuous EEG/EMG recordings were performed. EEG power
spectra were calculated for consecutive 4-­s epochs by the fast
Fourier transform. For each hour the mean energy in the delta,
theta, and sigma band as well as in slow (SWA, 0.5–4 Hz) and fast
wave activity (FWA, 7–25 Hz) were calculated over all vigilance
states (visually-­s cored).
Results: The first day of cold habituation increased the amount of
Wakefulness and decreased NREMS percentage (from 71.1 ± 4.2,
down to 59.8 ± 11.1 (p = 0.001) at the daytime. The Wakefulness
amount was lower, but amounts of NREMS (27.0 ± 19.6 vs 36.7 ± 30.9
(p = 0.03)) and REMS (3.8 ± 1.2 vs 5.8 ± 1.1 (p = 0.04)) higher to the
corresponding controls at the night period. Similar modifications in
vigilance states changes were found after 2-­nd day of cooling. There
were descending trends in the light period in NREMS delta and
SWA power hourly dynamics, but after 2-­nd cooling day the slopes
‘disappeared’. FWA ascending trends were found in all the cases. No
shifts in REMS theta peak caused by cold habituation were found.
The dark time beginning was characterized by a decrease of spectral
power in theta band in Wakefulness after cold exposures.
Conclusions: Cold habituation influenced sleep structure in rats: the
amount of Wakefulness increased and NREMS decreased at the light
time (with the rebound in NREMS at the dark time), and the per-
centage of REMS increased and Wakefulness decreased in the dark
period. The hourly dynamics in all studied EEG bands were mainly
unchanged.
Disclosure: Nothing to disclose.
P157 | Slow-­wave potentiation is age-­
dependent and characterizes early-­night sleep in
teenagers and young adults
K. van Welzen1,2; A. Muñoz-Lopetegi1,3; M. Rosa-Justicia1;
H. Stein1; A. Morató1; H. Ariño1; E. Martinez-Hernandez1,3;
T. Armangué1,3; G. Sugranyes1,4; J. Castro-Fornieles1,4; J.
Dalmau1,3,5; J. Santamaria1,3; A. Compte1
1
Institut d'Investigacions Biomèdiques August Pi i Sunyer IDIBAPS,
Barcelona, Spain; 2Amsterdam Brain and Cognition, University of
Amsterdam, Amsterdam, The Netherlands; 3Department of Neurology;
4
Department of Child and Adolescent Psychiatry and Psychology,
Hospital Clinic de Barcelona, Barcelona, Spain; 5Department of
Neurology, University of Pennsylvania, Philadelphia, PA, United States
Objectives/Introduction: Previous studies in rodents and humans
have suggested two potential roles of synaptic plasticity during
slow-­wave sleep,
1. it may serve as a homeostatic mechanism and globally reduce
synaptic strength during sleep, or
2. it may help memory consolidation through selective enhance-
ment of cortical synapses.
These mechanisms may dominate in different sleep periods or devel-
opmental stages. It has been argued that the fastest rate-­of-­change
(slope) of individual slow waves in electrophysiological recordings
is a marker of cortical synaptic strength (Vyazovskiy et al. Sleep
2007; 30:1631). Here, we examined the changes of human slow-­
wave slopes through nocturnal sleep in order to determine whether
distinct sleep plasticity mechanisms are engaged at different sleep
stages, and if developmental patterns exist in humans.
Methods: In a longitudinal study, EEG was recorded during one night
sleep in healthy participants (N = 22, ages 14–55, median 23, IQR
[18–27], 43-­channel EEG at 512 Hz) after 3-­hour testing in a visuo-
motor cognitive task. A subsample of the participants returned for
a second identical session 1 year later (N = 13). Detection of slow
waves during N3 sleep was done with the YASA algorithm (https://
doi.org/10.5281/zenodo.2370600), and the nocturnal evolution of
ABSTRACTS
their individual fastest rate-­of-­change (slopes) in frontal electrodes
was analyzed using linear models.
Results: Across all subjects, slow-­
wave slopes were smaller in
late-­night compared to early-­night N3 sleep periods, as reported
(Jaramillo et al. Sleep 2020, zsaa038), but the specific pattern of this
evolution was highly dependent on age. Younger participants had an
initial potentiation phase (maximal slow-­wave slope one third into
the night sleeping period), which was largely absent in older partici-
pants (>30 years old), for which slow-­wave slopes decreased steadily
from sleep onset. This was further verified in a within-­subject fol-
low-­up in 13 participants, where the initial potentiation phase was
diminished 1 year later, specifically for younger participants.
Conclusions: Slow-­wave sleep potentiation in early-­night N3 sleep
characterizes teenager and young adult sleep, and disappears in
older adults. Late-­night N3 sleep is characterized by progressive
slow-­wave sleep attenuation for all ages. This developmental and
temporal dissociation may reflect distinct but coexisting sleep plas-
ticity mechanisms, with early-­night synaptic potentiation followed
by synaptic homeostasis until awakening.
Disclosure: Nothing to disclose. Funding: Instituto de Salud Carlos
III, Cellex Foundation, La Caixa Banking Foundation, Ministry of
Science and Innovation of Spain.
P158 | Shift work-­related circadian disruption
on diurnal rest-­activity and sleep patterns in
morning-­and evening-­type first responders
under naturalistic conditions
I. Clark*1; B. Stucky*1,2; Y. Azza3,4; S. Müller5; W. Karlen6; E.
Seifritz2,4; B. Kleim3,4; H.-P. Landolt1,2
1
Institute of Pharmacology and Toxicology; 2Sleep & Health Zurich,
University Center of Competence; 3Department of Experimental
Psychopathology and Psychotherapy; 4Department of Psychiatry,
Psychotherapy and Psychosomatics, University Hospital for Psychiatry,
University of Zurich; 5Schutz & Rettung Zurich; 6Mobile Health
Systems Lab, Institute of Robotics and Intelligent Systems Department
of Health Sciences and Technology, Swiss Federal Institute of
Technology in Zurich, Zurich, Switzerland
*Shared first-authorship.
Objectives/Introduction: Prevalence of trauma and stressor-­related
disorders is increased among emergency first responders due to
routine trauma exposure, and their risk of shift work-­related ill-
nesses is high. Chronotype may impact self-­selected sleep timing
and quality, which may modulate stress resilience. We hypothesized
that chronotype may modulate resilience to posttraumatic stress
within this population.
Methods: To test this hypothesis, rest-­
activity behavior includ-
ing sleep in 84 paramedics and police (34.1  ±  7.9 [sd] years; 44
females) was monitored 30 days continuously with a commercial
wrist-­worn activity and pulse monitor, totaling 2,447 sleep episodes.
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Sleep quality and macrostructure were obtained in self-­selected
sleep episodes at different clock times. Resilience to posttraumatic
stress (PTSD Checklist for DSM 5; PCL-­5) and chronotype (Reduced
Morningness-­Eveningness Questionnaire; rMEQ) were assessed.
Results: Preferential evening-­t ype (n = 41; MEQ ≤ 14) and morning-­
type (n = 43; MEQ > 14) individuals organized sleep episodes differ-
ently, such that evening-­t ypes slept longer between 00:00–12:00 h
(p < 0.0001), whereas morning-­t ypes slept longer between 12:00–
24:00 h (p  <  0.0001). Nocturnal sleep duration (SD), however,
did not differ between morning-­types (7.58 ± 1.8 h) and evening-­
types (7.57 ± 2.1 h; p > 0.97). After 00:00 h, SD diverged, such that
evening-­t ypes slept typically 1.05 h longer than morning types be-
tween 00:00-­0 4:00 h (p < 0.0001), 04:00–08:00 h (p  <  0.05) and
08:00–12:00 h (p  <  0.001). Morning-­types (8.5 ± 10.7) reported
higher PCL-­5 scores (p < 0.05) than evening-­t ypes (5.8 ± 7.0).
Conclusions: Rest-­activity behavior including sleep was organized
differently under naturalistic settings in this sample of first responder
shift workers stratified by chronotype. Although morning-­
t ypes
and evening-­types did not differ in nocturnal SD, evening-­types
slept longer than morning-­types between 00:00–12:00 h. Evening
chronotypes may cope better with shift-­work-­related circadian mis-
alignment and irregular sleep-­wake schedules required by job de-
mands, which may be reflected in lower posttraumatic stress scores.
Supported by the Clinical Research Priority Program ‘Sleep & Health’ of
the University of Zürich.
Disclosure: Nothing to disclose.
P159 | Sleep in chronic pain conditions –
the 0.02 hz-­fluctuation reveals the hidden
microarousals
R. Cardis1; S. Lecci2; A. Osorio Forero1; L.M.J. Fernandez1;
M. Pertin3; I. Decosterd3; A. Lüthi1
1
DNF, Université de Lausanne; 2CIRS; 3Centre d'Antalgie, Centre
Hospitalier Universitaire Vaudois, Lausanne, Switzerland
Objectives/Introduction: Difficulties falling asleep and frequent
awakenings are among the main complaints of chronic pain patients.
In mice, the consequences of chronic pain on sleep architecture and
arousability are not well studied and a link to the symptomatology in
patients is difficult to establish.
Here, we re-­address the consequences of an experimental model of
neuropathic pain on sleep in mice. It has been previous shown that
central pain sensitization processes cause states of hyperexcitability
in the brain pain matrix. Therefore, we tested the hypothesis that
chronic pain may affect sleep particularly at moments of fragility,
when chances to wake-­up are high.
Methods: We obtained polysomnographic recordings from a well-­
established model of neuropathic pain, the spared nerve injury (SNI)
known to affect hindlimb cortical areas. The periods of non-­REM
sleep fragility were automatically detected based on a recently
 |
148 of 356       ABSTRACTS
described 0.02 Hz-­fluctuation in sigma power that declines during
fragility periods. Delta frequency dynamics of these fragility periods
were classified using unsupervised correlation and linkage methods.
Results: Animals with SNI (n = 18) showed unaltered sleep architec-
ture and mean spectral composition of wakefulness, non-­REM sleep
and REM sleep. However, non-­REM sleep was disturbed regard-
ing spectral hallmarks of non-­REM sleep fragility periods. The first
hallmark, the decline in sigma power, was unaltered in SNI animals.
However, classification by correlation revealed two main clusters of
delta activity in fragility periods. One of which showed a delta power
decline, normally associated with awakening, whereas the other one
a delta increase. Intriguingly, the former was more frequent in SNI
animals (35% of the fragility periods in baseline vs 42% after SNI,
p = 2.6e−3) and showed a similar course in the resting phase as micro-
arousals. Experiments to identify the cortical sites showing abnor-
mal fragility period hallmarks are currently on-­going.
Conclusions: Although SNI animals show apparently preserved non-­
REM sleep, we observe a higher number of attempted intrusions of
wakefulness at moments of fragility. We conclude that pain-­triggered
alterations in brain excitability may manifest themselves most during
moments of non-­REM sleep fragility, which could potentially under-
lie abnormal arousability. We are currently studying the behavioral
relevance by using targeted stimulus during periods of fragility.
Disclosure: Nothing to disclose.
P160 | Neurophysiology of NREM parasomnias
G. Mayer1; A. Heidbreder2; D. Krefting3
1 2
Neurology, Philipps University, Marburg, Germany; Neurology,
3
Universität Innsbruck, Innsbruck, Austria; Institut für Medizinische
Informatik, Universität Göttingen, Göttingen, Germany
Objectives/Introduction: The pathophysiology of NREM parasom-
nias is not well understood.
The study aims were to re-­investigate polysomnographies (PSG) in
a large sample of patients with NREM parasomnia the consistency
of several hypotheses from recent literature: Fragmentation of 1st
sleep cycles, delayed built up and decay of slow wave sleep, decrease
of slow wave sleep, increase of slow wave activity prior to events, to-
pography of sleepwalking (SW) events, neuronal networks involved
in SW, differences in SW events followed by sleep stage vs wake.
Methods: PSGs of 196 SW (ICSD 2/3 criteria) were compared to
PSGs of 110 age and sex matched controls from the SIESTA group.
Sleep staging was performed according to Rechtschaffen & Kales.
Time delay stability (TDS) was used to investigate brain connectivity.
Results: SW had more stage N3, no change in N3 latency, N3 in-
creased with age, N3 phases were less, but longer than in controls.
Wake after sleep onset was increased in the first sleep cycles, num-
ber of awakenings was slightly increased at night, transition from
N3-­wake was increased, and reduced from stage N3-­N2. Transition
probabilities showed more change from N2-­N3-­wake and wake-­N2.
TDS connectivity showed more elevated link ratios between fron-
tal and central locations and central and occipital locations in SW.
TDS connectivity 3 and 6 minutes prior to SW showed a tendency to
lower link ratios in the low frequency domain fronto-­occipital.
Conclusions: Our data confirm for SW: higher stability of N3, higher
N3 pressure, increased number of awakenings from N3, dissoci-
ated connectivity fronto-­occipital, increased WASO compared to
controls.
Disclosure: Nothing to disclose.
P161 | Effects of solriamfetol on 24-­hour blood
pressure patterns in participants with excessive
daytime sleepiness associated with obstructive
sleep apnoea
P.J. Strollo; Jr1; A. Malhotra2; K. Strohl3; J.-L. Pepin4; P.
Schweitzer5; G.J. Lammers6,7; J. Hedner8; M. Baladi9; L.
Carter9; S. Bujanover9; Y. Dauvilliers10
1
University of Pittsburgh/Veterans Administration Pittsburgh Health
System, Pittsburgh, PA; 2Division of Pulmonary, Critical Care and Sleep
Medicine, University of California San Diego Medical Center, La Jolla,
CA; 3Case Western Reserve University, Cleveland, OH, United States;
4
Grenoble Alpes University Hospital, Grenoble, France; 5Sleep Medicine
and Research Center, St. Luke's Hospital, Chesterfield, MO, United
States; 6Sleep-­Wake Centre, SEIN; 7Leiden University Medical Centre,
Department of Neurology, Leiden, The Netherlands; 8Sahlgrenska
University Hospital, Gothenburg University, Gothenburg, Switzerland;
9 10
Jazz Pharmaceuticals, Palo Alto, CA, United States; Gui-­de-­Chauliac
Hospital, Chumontpellier, France
Objectives/Introduction: Solriamfetol, a dopamine/norepinephrine
reuptake inhibitor, is approved in the EU and US to improve wake-
fulness in adults with excessive daytime sleepiness associated with
obstructive sleep apnoea (OSA; 37.5–150 mg/day). Previous solriam-
fetol studies reported small mean increases in blood pressure (BP)
in participants with OSA. These analyses evaluated the time course
of these effects and effects on nocturnal decreases in BP (‘dipping’;
‘non-­dipping’ is a risk factor for adverse cardiovascular outcomes) in
participants with OSA.
Methods: Twenty-­
four-­
hour ambulatory BP monitoring was con-
ducted at baseline and Week 8 in a 12-­week randomised controlled
trial in participants treated with placebo or solriamfetol (37.5, 75,
150, or 300 mg/day) (NCT02348606; EudraCT 2014-­0 05514-­31).
Mean BP in 2-­hour intervals across the day and the percentage of
participants with non-­dipping BP profiles were summarised (no for-
mal statistical analyses performed).
Results: The safety population included 474 participants. At base-
line, 50% (placebo) and 49% (combined solriamfetol) of participants
had hypertension, and 51% and 49%, respectively, used antihyper-
tensive medications. At Week 8, mean increases in BP were observed
in the 75 and 300 mg groups from ~6 AM until 8 PM; increases in
ABSTRACTS
the 37.5 and 150 mg groups were minimal. At baseline, 58% (pla-
cebo) and 55% (combined solriamfetol) of participants were non-­
dippers (defined as < 10% decrease in mean arterial pressure during
sleep). There was no increase in the percentage of non-­dippers at
Week 8 relative to baseline (placebo, 56%; combined solriamfetol,
53%). Results were similar when dipping was defined by changes in
mean systolic or diastolic BP. During the study, no placebo-­treated
participants and 1% of solriamfetol-­
treated participants initiated
antihypertensive medication. One participant (receiving 150 mg sol-
riamfetol) discontinued due to an adverse event (AE) of increased BP.
Conclusions: At baseline, approximately half the study population
had hypertension and/or used antihypertensive medications. Effects
of solriamfetol on BP at the highest approved dose (150 mg/day)
were transient across the day. The percentage of participants with a
non-­dipping BP profile did not increase with solriamfetol at any dose
studied. Few participants initiated new antihypertensive medication
or discontinued due to AEs of hypertension/increased BP.
Disclosure: PJ Strollo, Jr has received consultancy fees and honoraria
from Inspire Medical Systems, ResMed, Philips-­
Respironics, Emmi
Solutions, Jazz Pharmaceuticals, and Itamar; has received research
funding from the National Institutes of Health and Inspire Medical
Systems; and has a provisional patent for positive airway pressure with
integrated oxygen. A Malhotra has served as a principal investigator
for a Jazz study but receives no outside personal income as a recent
officer of the American Thoracic Society; ResMed gave a philanthropic
donation to the University of California, San Diego, in support of a
sleep centre. K Strohl has served as an advisory board member and is a
principal investigator for Jazz Pharmaceuticals. J-­L Pepin has received
lecture fees or conference traveling grants from Resmed, Perimetre,
Philips, Fisher and Paykel, AstraZeneca, Jazz Pharmaceuticals,
Agiradom, and Teva, and has received unrestricted research funding
from ResMed, Philips, GlaxoSmithKline, Bioprojet, Foundation de la
Recherche Medicale (Foundation for Medical Research), Direction de la
Recherche Clinique du CHU de Grenoble (Research Branch Clinic CHU
de Grenoble), and fond de dotation ‘Agir pour les Maladies Chroniques’
(endowment fund ‘Acting for Chronic Diseases’). P Schweitzer has
received research funding and lecture or conference traveling grants
from Jazz Pharmaceuticals, and research funding from Apnimed,
Balance Therapeutics, Avadel-­
Flamel, Harmony Biosciences, and
Suven Life Sciences. GJ Lammers has received consultancy fees and/
or honoraria and has been a speakers’ bureau member and/or an ad-
visory board participant for UCB Pharma, Bioprojet, Theranexus, and
Jazz Pharmaceuticals. J Hedner has served on the speakers’ bureaus
for AstraZeneca, Philips Respironics, Itamar Medical, and BresoTec,
and serves as a board member for Cereus Pharma. M Baladi, L Carter,
and S Bujanover are employees of Jazz Pharmaceuticals who, in the
course of this employment, have received stock options exercisable for,
and other stock awards of, ordinary shares of Jazz Pharmaceuticals plc.
Y Dauvilliers has received consultancy fees and/or honoraria and has
been a speakers’ bureau member and/or an advisory board participant
for UCB Pharma, Bioprojet, Theranexus, Idorsia, Takeda, Flamel, and
Jazz Pharmaceuticals.
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P162 | Effects of weight loss during long-­
term solriamfetol treatment on cardiometabolic
indices
A. Malhotra1; P.J. Strollo; Jr2; J.-L. Pepin3; P. Schweitzer4;
G.J. Lammers5,6; J. Hedner7; S. Redline8; D. Chen9; P.
Chandler9; S. Bujanover9; K. Strohl10
1
Division of Pulmonary, Critical Care and Sleep Medicine, University
of California San Diego Medical Center, La Jolla, CA; 2University
of Pittsburgh/Veterans Administration Pittsburgh Health System,
Pittsburgh, PA, United States; 3Grenoble Alpes University Hospital,
Grenoble, France; 4Sleep Medicine and Research Center, St. Luke's
Hospital, Chesterfield, MO, United States; 5Sleep-­Wake Centre, SEIN;
6
Department of Neurology, Leiden University Medical Centre, Leiden,
The Netherlands; 7Sahlgrenska University Hospital, Gothenburg
University, Gothenburg, Sweden; 8Brigham and Women's Hospital,
Harvard Medical School, Boston, MA; 9Jazz Pharmaceuticals, Palo Alto,
10
CA; Case Western Reserve University, Cleveland, OH, United States
Objectives/Introduction: Increased prevalence of obesity has been
reported in patients with narcolepsy and obstructive sleep apnoea
(OSA). Solriamfetol, a dopamine/norepinephrine reuptake inhibitor,
is approved in the EU and US to treat excessive daytime sleepiness
associated with narcolepsy (75–150 mg/day) or OSA (37.5–150 mg/
day). Results from a 1-­
year open-­
label extension (OLE) study
showed ≥ 5% weight loss in 4.5%, 17.3%, and 32.4% of participants
with narcolepsy or OSA receiving solriamfetol 75, 150, or 300 mg/d,
respectively. We examined whether clinically significant weight loss
(≥5%) in this population had favorable effects on biomarkers of car-
diometabolic risk compared to no such weight loss.
Methods: We summarised changes in weight and BP (parent study
baseline to OLE Week 40) and clinical laboratory assessments (OLE
baseline to OLE Week 40) in participants with narcolepsy (n = 124)
or OSA (n = 250) from the OLE study (NCT02348632). No formal
statistical comparisons were performed.
Results: Of 374 participants, 96 (25.7%) had ≥ 5% weight loss and
34 (9.1%) had ≥ 5% weight gain. Demographics were similar in those
with and without (n  =  278)  ≥  5% weight loss; mean baseline BMI
was 32.2 and 31.7, respectively. Among participants with weight
loss, there were decreases from baseline to Week 40 in the per-
centage of participants with high (ie, >ULN) serum glucose (36.6%
to 28.1%) or triglycerides (26.6% to 21.9%). In contrast, among
participants without weight loss, there was an increase in the per-
centage with high glucose (43.3% to 50.0%), and no change in the
percentage with high triglycerides (37.1% to 37.2%). The percentage
of participants with high total cholesterol was stable among partici-
pants with weight loss (22.3% to 22.9%) and increased (32.7% to
37.2%) in participants without weight loss. Participants with weight
loss had mean±SD reductions in SBP (−2.6 ± 11.4 mmHg) and DBP
(−1.0 ± 9.0 mmHg), whereas participants without weight loss had in-
creases of + 0.65 ± 12.5 mmHg and + 1.2 ± 8.7 mmHg, respectively,
compared with baseline.
 |
150 of 356       ABSTRACTS
Conclusions: In participants who lost ≥ 5% body weight, weight loss
was associated with decreases in BP and decreases in the percent-
age of participants with high glucose and triglycerides. Further re-
search is required to examine long-­term effects of solriamfetol on
specific biomarkers of cardiometabolic risk.
Disclosure: A Malhotra has served as a principal investigator for a Jazz
study but receives no outside personal income as a recent officer of
the American Thoracic Society; ResMed gave a philanthropic dona-
tion to the University of California, San Diego, in support of a sleep
center. PJ Strollo, Jr has received consultancy fees and honoraria from
Inspire Medical Systems, ResMed, Philips-­Respironics, Emmi Solutions,
Jazz Pharmaceuticals, and Itamar; has received research funding from
the National Institutes of Health and Inspire Medical Systems; and has
a provisional patent for positive airway pressure with integrated oxy-
gen. J-­L Pepin has received lecture fees or conference traveling grants
from Resmed, Perimetre, Philips, Fisher and Paykel, AstraZeneca, Jazz
Pharmaceuticals, Agiradom, and Teva, and has received unrestricted
research funding from ResMed, Philips, GlaxoSmithKline, Bioprojet,
Fondation de la Recherche Medicale (Foundation for Medical Research),
Direction de la Recherche Clinique du CHU de Grenoble (Research
Branch Clinic CHU de Grenoble), and fond de dotation ‘Agir pour les
Maladies Chroniques’ (endowment fund ‘Acting for Chronic Diseases’).
P Schweitzer has received research funding and lecture or conference
traveling grants from Jazz Pharmaceuticals, and research funding from
Apnimed, Balance Therapeutics, Avadel-­Flamel, Harmony Biosciences,
and Suven Life Sciences. GJ Lammers has received consultancy fees
and/or honoraria and has been a speakers’ bureau member and/or an
advisory board participant for UCB Pharma, Bioprojet, Theranexus, and
Jazz Pharmaceuticals. J Hedner has served on the speakers’ bureaus
for AstraZeneca, Philips Respironics, ItamarMedical, and BresoTec, and
serves as a board member for Cereus Pharma. S Redline has received
research funding and consulting fees from Jazz Pharmaceuticals and
consulting fees from RespirCardia and Eisai Pharma. D Chen, P Chandler,
and S Bujanover are employees of Jazz Pharmaceuticals who, in the
course of this employment, have received stock options exercisable for,
and other stock awards of, ordinary shares of Jazz Pharmaceuticals plc. K
Strohl has served as an advisory board member and is a principal investi-
gator for Jazz Pharmaceuticals.
P163 | Can algorithms that analyze machine
data predict adherence to CPAP therapy? Data
from the Pays de la Loire Sleep Cohort
A. Sabil1; C. Stitt2; M. Le Vaillant3; N. Meslier4; F. Gagnadoux4
1
Clinical Research, Philips SRC, Paris, France; 2Philips SRC, Pittsburgh,
PA, United States; 3Institut de Recherche en Santé Respiratoire des
Pays de la Loire; 4Département de Pneumologie, Université d'Angers &
CHU d'Angers, Angers, France
Objectives/Introduction: Adherence is a critical issue in the treat-
ment of sleep apnea with continuous positive airway pressure
(CPAP). Approximately 40% of patients treated with CPAP are at
risk of treatment discontinuation or insufficient use (< 4 h/night).
Assuming that the first few days on CPAP are critical for continued
treatment, we evaluated whether the Philips Adherence Profiler™
(AP) algorithm at day 14 (D14) could predict CPAP adherence at
3 months (D90).
Methods: The AP algorithm uses CPAP machine data hosted in the
database of EncoreAnywhere™. This retrospective study involved
487 patients (65.9% male, 60 ± 11.9 years; BMI = 31.2 ± 5.9 kg/m2;
AHI = 37.8 ± 19.2; Epworth score = 10.0 ± 4.8) from the Pays de la
Loire Sleep Cohort. At D90, 87.5% of the patients were adherent as
defined by a daily CPAP use ≥ 4 h.
Results: In univariate analysis, the factors significantly associated
with CPAP adherence at D90 were age (odds ratio (OR) 1.82 (95% CI
1.37–2.41)), BMI (OR 0.69 (95% CI 0.53 0.90)), and AP prediction at
D14 (OR 18.6 (95% 9.7–35.6)). There was a non-­significant trend for
gender, marital status, and occupational status (p = 0.058, 0.076, and
0.078 respectively). In multivariate analysis only the AP prediction
at D14 was an independent predictor of CPAP adherence (OR 19.2
(95% CI 9.2–40.3)).
Conclusions: These results suggest that the Adherence Profiler™
algorithm is a relevant tool for predicting CPAP compliance at
D90 as early as D14. This algorithm could help focusing therapeu-
tic follow-­up efforts on patients detected early as being at risk of
non-­adherence.
Disclosure: Both A.S and C.S work for Philips.
P164 | Assessing the burden of excessive
daytime sleepiness associated with obstructive
sleep apnoea: a time trade-­off study in the UK
general public
K. Tolley1; S. Mettam2; J. Noble-Longster1; R. Hibbs1; L.
Stainer1; M. Cawson1; A. Manuel3
1
Tolley Health Economics Ltd., Buxton, Derbyshire; 2Jazz
Pharmaceuticals, Oxford; 3Liverpool University Hospital NHS
Foundation Trust, Liverpool, United Kingdom
Objectives/Introduction: Approximately 9–22% patients with
obstructive sleep apnoea (OSA) suffer from excessive daytime
sleepiness (EDS) despite primary treatment. EDS is associated with
negative impacts on quality of life (QoL) and increased risk of work-
place and driving accidents. It is important for Health Technology
Assessment that disease impact is quantified. This study aimed to
obtain utility values for different EDS severity states associated with
OSA, from the perspective of the patient or partner of the patient.
Methods: A time trade-­off (TTO) study was conducted via software-­
led, face-­to-­face interviews. TTO is a method of assessing changes
in perceived QoL across health states. Various states are described
and participants ‘trade-­off’ time in a described state for a shorter
period in full health (e.g. ‘Would you prefer 10 years in health state X
ABSTRACTS
or 6 years in full health?’). Utility is calculated based on the amount
of time traded (e.g. utility of 0.5 = 5 years traded). This enables the
utility measure to be normally bounded between 0 (equivalent to
death) and 1 (best imaginable health) and allows for comparison
across diseases.
One hundred members of the public were interviewed with recruit-
ment split across socio-­economic, age, and other aspects, ensuring
the sample was broadly representative of the UK population. Each
participant completed responses for both the patient perspective
and the partner of a patient perspective. States considered were: no
EDS, mild EDS, moderate EDS, severe EDS.
Results: Average utility scores declined (worsening QoL) with in-
creasing severity of EDS in OSA: no EDS, 0.926; mild EDS, 0.794;
moderate EDS, 0.614; severe EDS, 0.546. The partner perspective
health state scores also declined with increasing severity of EDS in
OSA, although partner scores were consistently higher (less severe)
than patient scores: no EDS, 0.955; mild EDS, 0.882; moderate EDS,
0.751; severe EDS, 0.670.
Conclusions: These results demonstrate the high impact of EDS in
OSA on patient and partner well-­being and QoL. Importantly, for
the first time, the impact on the partner was assessed and a notable
burden was demonstrated. These values can be used in cost-­utility
analyses evaluating new healthcare interventions for EDS in OSA.
Disclosure: K Tolley, J Noble-­Longster, R Hibbs, L Stainer, and M
Cawson are employees of Tolley Health Economics, Buxton, UK,
who received funding from Jazz Pharma to complete this work. S
Mettam is an employee of Jazz Pharmaceuticals who, in the course
of his employment, has received stock options exercisable for, and
other stock awards of, ordinary shares of Jazz Pharmaceuticals plc.
A Manuel is an employee of Liverpool University Hospital NHS
Foundation Trust, UK, who has received consulting fees from Jazz
Pharma.
P165 | CPAP-­treatment may improve sensory
function in the soft palate of obstructive sleep
apnea patients
H. Rashed1; E. Svanborg2
1
Dept of Ear-­Nose and Throat, University Hospital Linköping; 2Dept of
Clinical Nerophysiology, Linköping University and University Hospital,
Linköping, Sweden
Objectives/Introduction: Signs of both motor and sensory nervous
lesions have previously been shown in the upper airway of patients
with OSA (obstructive sleep apnea) and habitual snorers. Snoring per
se may damage upper airway neurons over time, thereby causing pro-
gression to manifest sleep apnea. In a previous study, non-­snorers,
untreated snorers/OSA-­patients and CPAP-­treated patients under-
went repeated sensory testing of the soft palate with 6 years inter-
val. The untreated snorers got significantly worse values, whereas
the CPAP-­treated patients did not; some of them even improved.
|
      151 of 356
The current study was performed to test whether improvement of
sensory function could occur very early during CPAP-­treatment.
Methods: Cold detection threshold testing (CDT) was performed
on 13 OSA-­patients (AHI 9–48, ages 38–70 years) using a Medoc
TSA-­2001 with an intra-­oral thermode, placed at the raphe of the
soft palate on the left side of the uvula, on the day the patients′
CPAP-­treatment was initiated. Repeated testing was planned after
one month's use of CPAP, at least 4 hours per night.
Results: Only 9 patients became regular CPAP-­users and came back
for renewed testing. Of those, five with moderate to severe patho-
logical first testing results (cold detection thresholds 12.4–36°C)
had improved or even normalized secondary values (5.0–10.0 °C).
Of four patients with initial normal values (1.8–6.8°C), three were
unchanged, and one patient had worse values. For the whole group,
the change between first and second tests was not statistically
significant.
Conclusions: Already after 1–2 months of CPAP-­treatment some
OSA-­patients may get markedly improved sensory function in the
upper. airway. It was noteworthy that this was found only in those
patients who initially had poor cold sensitivity in this study. One
may speculate that the reason for this is that normalized airflow and
abolition of snoring vibrations will reduce turgor of the soft tissues,
thereby improving sensation, since sensory reinnervation is not likely
have occurred after such a short time. The study will continue with
a larger number of patients of different ages and disease severity.
Disclosure: Nothing to disclose.
P166 | Trends in the use of medications with
insomnia side effects and the implications for
insomnia among U.S. adults
D. Do
University of Pennsylvania, Philadelphia, PA, United States
Objectives/Introduction: Adults in more-­developed countries are
increasingly relying on pharmaceuticals that although effective
in treating their focal indication, include insomnia as a side effect.
Regardless, no studies have documented trends in the use of these
medications and the implications of their use for the growing preva-
lence of insomnia at the population level.
Methods: We used a nationally representative sample of U.S. adults
(n = 49,512) from the 1999–2016 National Health and Nutrition
Examination Survey (NHANES). We adjusted for the complex sam-
pling of the NHANES survey by calculating the weighted annual
prevalence of consuming medications with insomnia side effects.
We then used logistic regression to investigate the statistical sig-
nificance of trends of medications with insomnia side effects from
1999 to 2016. We used multivariate linear least squared and logistic
models to assess the association between insomnia and the use of
medications with insomnia side effects.
 |
152 of 356       ABSTRACTS
Results: From 1999 to 2016, the use of one or two and three or more
medications with insomnia side effects increased by 25% and 272%,
respectively. Compared to non-­users, respondents who took three
or more of these medications were 1.30 times (95% CI, 1.01 to 1.67)
more likely to report insomnia symptoms and 2.39 times (95% CI,
1.65 to 3.46) more likely to have difficulty with at least two daytime
activities.
Conclusions: These findings suggest that the insomnia side effect of
medications has likely been underappreciated by medical providers,
and that any insomnia side effect can be later treated by prescrib-
ing insomnia medications. In addition, polypharmacy may present
unique risks for insomnia side effects, amplifying the effects of each
of the medications in a set. Lastly, the results have important im-
plications for socio-­demographic disparities in insomnia: the higher
prevalence of insomnia among some subgroups may be in part due
to their higher prevalence of using medications with insomnia side
effects than other groups.
Disclosure: Nothing to disclose.
P167 | Daridorexant, a novel dual orexin
receptor antagonist, delivers significant
improvement in sleep parameters and daytime
function for patients with insomnia disorder
T. Roth1; G. Zammit2; E. Mignot3; D. Leger4; C. Bassetti5; S.
Pain6; D. Seboek Kinter6
1
Division of Sleep Medicine and Research Center, Henry Ford
Health System, Detroit, MI; 2Clinilabs, Inc, New York, NY; 3Center
for Narcolepsy, Stanford Medicine, Stanford, CA, United States;
4
Universite Paris Descartes AP-­HP, Paris, France; 5Inselspital
6
Universitätsklink für Neurologie, Bern; Idorsia Pharmaceuticals Ltd.,
Allschwil, Switzerland
Objectives/Introduction: Daytime function impairment is key to an
insomnia diagnosis. Yet, available treatments primarily induce and
maintain sleep, without indication for daytime improvement. We re-
port on the phase 3 daridorexant trial.
Methods: In this multi-­
centre, phase-­
3, double-­
blind, placebo-­
controlled, parallel-­group study, 930 adult and elderly patients with
insomnia were randomised (1:1:1) to placebo, daridorexant 25 mg or
50 mg, taken nightly for 3 months, after a week placebo run-­in and
followed by a week placebo run-­out. Primary endpoints were change
(in minutes) from baseline in wake time after sleep onset (WASO)
and latency to persistent sleep (LPS) measured by polysomnogra-
phy at 1M and 3M. Secondary endpoints were change (in minutes)
from baseline in subjective total sleep time (sTST) and daytime func-
tion using the sleepiness domain of the validated Insomnia Daytime
Symptoms and Impacts Questionnaire (IDSIQ) at 1M and 3M. Study-­
wise type I error (5%) was controlled across the primary and second-
ary endpoints for each active dose comparison vs placebo. Other
endpoints included the IDSIQ total score and its Alert/Cognition and
Mood domains.
Results: Daridorexant 25 mg and 50 mg (vs. placebo) significantly
improved WASO at 1M (−18.40, −28.98 vs −6.20) and at 3M (−22.97,
−29.41 vs −11.11) and also LPS at 1M (−28.17, −31.20 vs. −19.85)
and at 3M (−30.73, −34.80 vs −23.13) (all p < 0.002 vs placebo).
Daridorexant 25 mg and 50 mg (vs placebo) increased sTST at 1M
(34.18 [p  =  0.0013], 43.62 [p < 0.0001], 21.56), and at 3M (47.85
[p = 0.0334], 57.67 [p < 0.0001], 37.90). Daridorexant 50 mg signifi-
cantly improved IDSIQ sleepiness domain scores at 1M and 3M (vs
placebo, p < 0.0003). Daytime function improved from baseline at
1M and 3M for the IDSIQ total score and other individual domains
for 50 mg (vs. placebo, p = 0.0005 to < 0.0001). For 25 mg there was
improvement at 1M and 3M vs placebo for the IDSIQ total score
(p < 0.05), mood (p < 0.004), alert/cognition (p = 0.21) and sleepiness
domains (p-­values = 0.05). The most frequent AEs, nasopharyngitis
and headache, were balanced between arms. No withdrawal symp-
toms nor rebound effects were observed during the run-­out.
Conclusions: Daridorexant improved not only objective and subjec-
tive sleep parameters, but also daytime function using a validated
instrument, while exhibiting an acceptable safety profile.
Disclosure: This study was funded by Idorsia Pharmaceuticals Ltd.
P168 | Subtypes of cognitive-­behavioural
therapy for insomnia efficacy in a long-­term
follow-­up
V. Castronovo1; A. Galbiati2; M. Sforza3; C. Leitner2; A.
Filice2; F. Casoni1; M. Zucconi1; L. Ferini Strambi2
1
IRCCS San Raffaele Scientific Institute, Department of Clinical
Neurosciences, Neurology – Sleep Disorders Center, Milan, Italy;
2
Faculty of Psychology, ‘Vita-­Salute’ San Raffaele University, Milan,
Italy, Milan; 3Faculty of Psychology, ‘Vita-­Salute’ San Raffaele
University, Milan, Italy, Milano, Italy
Objectives/Introduction: Insomnia disorder (ID) is characterized
by high degree of heterogeneity, that might influence treatment
response. The aim of this study is to identify ID patients’ subtypes
based on clinical features and their response to CBT-­I in a long-­term
follow-­up evaluation.
Methods: 294 chronic insomnia patients (female = 61.6%, mean
age = 40.7 ± 12.3 yrs) underwent 7-­sessions group CBT-­I. Using
latent class analysis (LCA), we identified ID subtypes according to
baseline (BL) evaluation of sleep and non-­sleep indices, as well as
CBT-­I response (Insomnia Severity Index Delta score, ISI BL – ISI
at the end of the treatment, END). Moreover, we assessed ISI in
123 out of 294 insomnia patients (82 females (66.7%), mean age
40.6 ± 11.9 years) who completed a follow-­up evaluation (FU) within
a range of 4–10 years (mean = 7.8 ± 1.6 years after the END of
treatment).
ABSTRACTS
Results: We chose 3 latent classes as most parsimonious model.
According to symptoms significance (questionnaires’ cut-­
offs),
we labeled three classes: Class 1 (pure Insomnia, n = 79), Class 2
(Insomnia+Anxiety, n = 153), Class 3 (Insomnia+Anxiety+Depression
+Stress, n = 62). In all three classes the CBT-­I effect was maintained
up to 10 years after the END but with significant difference between
subgroups (p < 0.05). At the END, the largest percentage of respond-
ers (ISI decrease ≥ 8) was found in Class 3 (63.5%). Results of over-
all CBT-­I effectiveness showed: in Class 1, 98.6% had subthreshold
insomnia (ISI score = 0–14) at the END, and 97.2% at the FU; in
Class 2, END = 89.0%, and FU = 78.2%; in Class 3, END = 80.7%
and FU = 51.8%. Moreover, we found a significant interaction be-
tween treatment and, respectively, stress and depression at BL
(Sig.=Treatment*PSS_BL < 0.05; Sig.=Treatment*BDI_BL < 0.05).
Conclusions: Our data driven analysis identified three different
subtypes of insomniacs on the basis of sleep and non-­sleep clinical
outcomes. The presence of stress and depression did not diminish
the effect of CBT-­I at short term. However, ID patients character-
ized by the presence of stress and depression (Class 3) were the best
responders at the end of treatment but this was not maintained at
the FU evaluation. Moreover, depression and stress at BL seem to
predict CBT-­I outcomes and can be considered possible risk factors
for long-­term CBT-­I outcome.
Disclosure: Nothing to disclose.
P169 | Insomnia affects brain reactivity to
humorous films
E. Sanz-Arigita1; Y. Daviaux2; M. Joliot3; J.-A. Micoulaud-
Franchi2; B. Dilharreguy1; S. Bioulac2; P. Philip2; E. Altena2
1
Institut de Neurosciences Cognitives et Intégratives d'Aquitaine
UMR5287; 2SANPSY-­USR CNRS 3413; 3GIN, UMR 5296, CNRS, CEA,
Université de Bordeaux, Bordeaux Cedex, France
Objectives/Introduction: Emotional reactivity for negative stimuli is
affected in insomnia (Baglioni et al., 2014), but little is known about
reactions to positive stimuli, and whether these would be more simi-
lar to sleep deprivation (increased reactivity: Gujar et al., 2011) or
comorbid depression (blunted reactivity: Hill et al., 2019). We thus
investigated if presenting short humorous films would lead to af-
fected emotional brain reactivity in younger adult insomnia patients.
Methods: We used 3T fMRI to determine neural reactivity dur-
ing the presentation of standardized short, 10–40-­
s, humorous
films in 20 individuals with DSM-­
5-­
diagnosed insomnia (aged
27.7 ± 8.6 years) and 20 age-­matched individuals without insomnia
(26.7 ± 7.0). Humor ratings were assessed through a visual analogue
scale (VASfm). Seed-­based functional connectivity analyses of the
left and right amygdala networks were performed on brain activity
evoked by movies rated as humourous, with a VASfm score of ≥ 2.
Statistical significance was defined as Z > 2.3 and p < 0.01, cluster
corrected.
|
      153 of 356
Results: In the absence of group differences on movie ratings
(p = 0.400), fMRI seed-­based analysis revealed that insomnia pa-
tients showed stronger neural reactivity than controls in several
brain network clusters within the emotional reactivity network. For
connectivity with the left amygdala, cluster maxima were in the left
caudate (Z = 3.88), left putamen (Z = 3.79) and left anterior cingulate
gyrus (Z = 4.11). For connectivity with the right amygdala, cluster
maxima were in the left caudate (Z = 4.05), right insula (Z = 3.83) and
left anterior cingulate gyrus (Z = 4.29). Control participants did not
show significantly increased neural reactivity compared to insomnia
patients in any cluster.
Conclusions: Increased brain activity in the emotional reactivity
network was found in insomnia patients compared to controls when
viewing humorous films, in the absence of humor rating group dif-
ferences. Of particular interest is that the reported brain regions are
important hubs of the reward network (https://www.neuro​synth.
org/analy​ses/terms/​rewar​d/). Neural reactivity patterns to positive
emotional stimuli in insomnia may thus reflect sleep deprivation ef-
fects more than depression effects in younger adults.
References:
Baglioni et al., Sleep 37, p. 1907–1917, 2014
Gujar et al.. J. of Neuroscience 31, p. 4466–4474, 2011
Hill et al., Biol. Psychology 141, p. 35–43, 2019
Disclosure: Nothing to disclose.
P170 | Effects of solriamfetol on 24-­hour blood
pressure patterns in participants with excessive
daytime sleepiness associated with narcolepsy
P.J. Strollo, Jr1; A. Malhotra2; K. Strohl3; J.-L. Pepin4; P.
Schweitzer5; G.J. Lammers6,7; J. Hedner8; M. Baladi9; L.
Carter9; S. Bujanover9; Y. Dauvilliers10
1
University of Pittsburgh/Veterans Administration Pittsburgh Health
System, Pittsburgh, PA; 2Division of Pulmonary, Critical Care and Sleep
Medicine, University of California San Diego Medical Center, La Jolla,
CA; 3Case Western Reserve University, Cleveland, OH, United States;
4
Grenoble Alpes University Hospital, Grenoble, France; 5Sleep Medicine
and Research Center, St. Luke's Hospital, Chesterfield, MO, United
States; 6Sleep-­Wake Centre, SEIN; 7Department of Neurology,, Leiden
University Medical Centre, Leiden, The Netherlands; 8Sahlgrenska
University Hospital, Gothenburg University, Gothenburg, Sweden; 9Jazz
10
Pharmaceuticals, Palo Alto, CA, United States; Gui-­de-­Chauliac
Hospital, Chumontpellier, France
Objectives/Introduction: Solriamfetol is a dopamine/norepineph-
rine reuptake inhibitor approved in the EU and US to improve wake-
fulness in adults with excessive daytime sleepiness associated with
narcolepsy (75–150 mg/day). Previous solriamfetol studies in par-
ticipants with narcolepsy reported small mean increases in blood
pressure (BP). The current analyses evaluated effects on BP across
the day and on nocturnal BP decreases (‘dipping’; ‘non-­dipping’ is a
 |
154 of 356       ABSTRACTS
risk factor for adverse cardiovascular outcomes) in participants with
narcolepsy.
Methods: Twenty-­four-­hour ambulatory blood pressure monitoring
was conducted at baseline and Week 8 in a 12-­week randomised con-
trolled trial in participants treated with placebo or solriamfetol (75,
150, or 300 mg/day) (NCT02348593; EudraCT 2014-­0 05487-­15).
Mean BP in 2-­hour intervals across the day and the percentage of
participants with non-­dipping BP profiles were summarised (no for-
mal statistical analyses performed).
Results: The safety population included 236 participants. At base-
line, 20% (placebo) and 17% (combined solriamfetol) of participants
had hypertension, and 19% and 16%, respectively, used antihy-
pertensive medications. At Week 8, mean increases in BP were
observed in the 150 mg group from 8 AM until 4 PM and in the
300 mg group from 8 AM until 6 PM. At baseline, 52% (placebo)
and 48% (combined solriamfetol) of participants were non-­dippers
(defined as < 10% decrease in mean arterial pressure during sleep).
There was no increase in the percentage of non-­dippers at Week
8 relative to baseline (placebo, 44%; combined solriamfetol, 39%).
Results were similar when dipping was defined by changes in mean
systolic or diastolic BP. During the study, 2% and 1% of placebo-­
and solriamfetol-­treated participants, respectively, initiated antihy-
pertensive medication. No participants discontinued due to adverse
events (AEs) of hypertension or increased BP.
Conclusions: At baseline, approximately one fifth of the study popu-
lation had hypertension and/or used antihypertensive medications.
Effects of solriamfetol on BP at the highest approved dose (150 mg/
day) were transient across the day. The percentage of participants
with a non-­dipping BP profile did not increase with solriamfetol at
any dose studied. Few participants initiated new antihypertensive
medication during the study, and none discontinued due to AEs of
hypertension/increased BP.
Disclosure: PJ Strollo, Jr has received consultancy fees and honoraria
from Inspire Medical Systems, ResMed, Philips-­Respironics, Emmi
Solutions, Jazz Pharmaceuticals, and Itamar; has received research
funding from the National Institutes of Health and Inspire Medical
Systems; and has a provisional patent for positive airway pressure
with integrated oxygen. A Malhotra has served as a principal inves-
tigator for a Jazz study but receives no outside personal income as
a recent officer of the American Thoracic Society; ResMed gave a
philanthropic donation to the University of California, San Diego, in
support of a sleep centre. K Strohl has served as an advisory board
member and is a principal investigator for Jazz Pharmaceuticals. J-­L
Pepin has received lecture fees or conference traveling grants from
Resmed, Perimetre, Philips, Fisher and Paykel, AstraZeneca, Jazz
Pharmaceuticals, Agiradom, and Teva, and has received unrestricted
research funding from ResMed, Philips, GlaxoSmithKline, Bioprojet,
Foundation de la Recherche Medicale (Foundation for Medical
Research), Direction de la Recherche Clinique du CHU de Grenoble
(Research Branch Clinic CHU de Grenoble), and fond de dotation
‘Agir pour les Maladies Chroniques’ (endowment fund ‘Acting for
Chronic Diseases’). P Schweitzer has received research funding and
lecture or conference traveling grants from Jazz Pharmaceuticals,
and research funding from Apnimed, Balance Therapeutics, Avadel-­
Flamel, Harmony Biosciences, and Suven Life Sciences. GJ Lammers
has received consultancy fees and/or honoraria and has been a
speakers’ bureau member and/or an advisory board participant for
UCB Pharma, Bioprojet, Theranexus, and Jazz Pharmaceuticals. J
Hedner has served on the speakers’ bureaus for AstraZeneca, Philips
Respironics, Itamar Medical, and BresoTec, and serves as a board
member for Cereus Pharma. M Baladi, L Carter, and S Bujanover
are employees of Jazz Pharmaceuticals who, in the course of this
employment, have received stock options exercisable for, and other
stock awards of, ordinary shares of Jazz Pharmaceuticals plc. Y
Dauvilliers has received consultancy fees and/or honoraria and has
been a speakers’ bureau member and/or an advisory board par-
ticipant for UCB Pharma, Bioprojet, Theranexus, Idorsia, Takeda,
Flamel, and Jazz Pharmaceuticals.
P171 | Maturational and developmental
trajectories of slow and fast frequency activity in
the transition from childhood to adolescence: the
Penn State Child Cohort
J. Fernandez-Mendoza1; A. Ricci1; F. He2; J. Fang1; S.
Calhoun1; A. Vgontzas1; D. Liao2; E. Bixler1
1
Sleep Research & Treatment Center | Psychiatry & Behavioral Health;
2
Public Health Sciences, Penn State College of Medicine, Hershey, PA,
United States
Objectives/Introduction: Non-­rapid eye movement (NREM) sleep
experiences significant changes during the transition from child-
hood to adolescence, which is a critical developmental period for
the onset of psychopathology. We examined the maturational tra-
jectories of slow and fast EEG activity during NREM sleep in a large,
longitudinal, population-­based cohort.
Methods: We studied 700 children (5–12, 47.1% female) from the
Penn State Child Cohort, of whom 421 were followed up as adoles-
cents (12–23, 46.1% female). Subjects underwent 9-­hour polysom-
nography (PSG) at both time points. We performed spectral analyses
of centroparietal EEG channels during NREM sleep. We modelled
cross-­
sectional (maturational) and longitudinal (developmental)
trajectories of delta (0.4–4.0 Hz) and beta (15.0–30.0 Hz) absolute
power in 670 children and adolescents from age 5 to 23. We tested
linear, quadratic and cubic terms for age and estimated the longitu-
dinal change in power from baseline (childhood) to follow-­up (ado-
lescence). In these regression models, we controlled for sex, race/
ethnicity, BMI percentile, AHI, use of psychoactive medications, and
PSG system.
Results: We found a significant maturational trajectory in which
delta power slightly increased from age 5 to 9, declined steeply
around age 12, reached its nadir by age 17, and stabilized at age
19 onwards (p-­cubic < 0.001). Females started the decline in delta
power earlier than males (age 11) and their longitudinal change was
ABSTRACTS
of greater magnitude by age 12–13 (−33.7% vs. −11.9%), while males
experienced a steeper decline in delta power from age 14 onwards
and their longitudinal change was of greater magnitude by age 18 on-
wards (−60.6% vs. −74.4%). No significant maturational trajectories
(linear, quadratic nor cubic) were observed for beta power, except an
overall longitudinal increase (+49.3%) that was of greater magnitude
in males (+64.0%) than females (+30.3%) until age 16.
Conclusions: This study provides robust population-­based evidence
for the steep decline in slow-­wave activity from childhood to adoles-
cence as a result of neurodevelopmental processes, including synaptic
pruning and streamlining of neural circuits. Future studies will examine
whether disruption of these maturational or developmental trajecto-
ries is associated with adverse neurobehavioral outcomes transdiag-
nostic across psychopathology in youth from the general population.
Disclosure: Research reported in this abstract was supported in
part by the National Institute of Mental Health (NIMH), National
Heart, Lung, and Blood Institute (NHLBI) and the National Center for
Advancing Translational Sciences (NCATS) of the National Institutes of
Health under Awards Number R01MH118308 (Fernandez-­Mendoza),
R01HL136587 (Fernandez-­
Mendoza), R01HL97165 (Bixler/Liao),
R01HL63772 (Bixler) and UL1TR000127 (Sinoway). The content is
solely the responsibility of the authors and does not necessarily repre-
sent the official views of the National Institutes of Health.
P172 | Maturational and developmental
trajectories of sigma-­frequency activity in the
transition from childhood to adolescence: the
Penn State Child Cohort
A. Ricci1; F. He2; J. Fang1; S. Calhoun1; A. Vgontzas1; D.
Liao2; E. Bixler1; J. Fernandez-Mendoza1
1
Sleep Research & Treatment Center | Psychiatry & Behavioral Health;
2
Public Health Sciences, Penn State College of Medicine, Hershey, PA,
United States
Objectives/Introduction: The transition from childhood to ado-
lescence is a critical period of development during which the brain
undergoes significant structural and functional changes, which are
reflected in the sleep electroencephalogram (EEG). We examined
the maturational and developmental trajectories of sigma-­frequency
activity during non-­rapid eye movement (NREM) sleep in a large, lon-
gitudinal, random-­sample of children and adolescents.
Methods: We studied 700 children (5–12y, 47.1% female) from the
Penn State Child Cohort, 421 of whom were followed-­up as adoles-
cents (12–23y, 46.1% female). Subjects underwent 9-­hour polysom-
nography (PSG) at baseline and follow-­up. Spectral analyses were
performed on central EEG channels (C3-­M2, C4-­M1) during NREM
sleep. We modelled cross-­
sectional (maturational) and longitudi-
nal (developmental) trajectories of sigma (11.33–14.84 Hz) absolute
power in 670 children and adolescents from 5 to 23 years, testing lin-
ear, quadratic, and cubic terms for age. We estimated the longitudinal
|
      155 of 356
change in sigma power from baseline (childhood) to follow-­up (ado-
lescence) in 418 subjects. We controlled for sex, race/ethnicity, BMI
percentile, AHI, psychoactive medications, and PSG system.
Results: The maturational trajectory of sigma power was best fit by
a quadratic model (p-­quadratic = 0.02) in which sigma power gradu-
ally increased from age 6 to 11, peaked between ages 12 and 14,
then declined from age 15 to 21. Males experienced an inverted U-­
shaped trajectory (p-­quadratic < 0.01), while sigma power in females
remained more stable across childhood and adolescence. The lon-
gitudinal change in sigma power from age 5–7 to age 12–13 years
was + 8.1%, while the longitudinal change from age 8–12 to
20–23 years was −31.7%.
Conclusions: NREM sigma power shows maturational and devel-
opmental trajectories distinct from the steep decline in delta (0.4–
4.0 Hz) power shown to occur after the onset of puberty (age 11).
The increase in sigma power until early adolescence (age 13) may
represent the emergence of mature centro-­parietal fast spindles dur-
ing adolescence, while the gradual decline after mid-­adolescence (age
15) may be associated with synaptic pruning and streamlining neural
circuits. Sigma power appears to be trait-­like in females, while males
show greater developmental changes in sigma power during this tran-
sitional period. Future studies will examine the trajectories of sleep
spindles and their relationship with neurobehavioral functioning.
Disclosure: Research reported in this abstract was supported in part
by the National Institute of Mental Health (NIMH), National Heart,
Lung, and Blood Institute (NHLBI) and the National Center for
Advancing Translational Sciences (NCATS) of the National Institutes
of Health under Awards Number R01MH118308 (Fernandez-­
Mendoza), R01HL136587 (Fernandez-­
Mendoza), R01HL97165
(Bixler/Liao), R01HL63772 (Bixler) and UL1TR000127 (Sinoway).
The content is solely the responsibility of the authors and does not
necessarily represent the official views of the National Institutes of
Health.
P173 | Sleep-­related strengthening of
functional connectivity in caudal and motor
cortical areas support problem solving
N.H. van den Berg1; D. Smith1; Z. Fang1; S. Fogel1,2
1
Psychology, University of Ottawa; 2Royal Ottawa Mental Health
Centre, Ottawa, ON, Canada
Objectives/Introduction: Sleep has been shown to enhance the
consolidation of newly acquired procedural skills (Diekelmann &
Born, 2010). Increased functional connectivity with the putamen
has been observed within a striatal-­hippocampal-­motor cortical net-
work, which supports motor procedural skill learning (Vahdat et al.,
2017). However, procedural learning differs based on skill complex-
ity, whereby sleep benefits cognitively complex aspects over simpler
aspects of skill learning (van den Berg et al., 2019; Kuriyama et al.,
2004; Ramanathan et al., 2015). To date, most functional connectivity
 |
156 of 356       ABSTRACTS
research regarding procedural learning has examined how motor skills
differ from perceptual skills (Darainy et al., 2013; Vahdat et al., 2011;
2014; Lammeti et al., 2012). In the current study, we investigated the
degree to which sleep benefits a cognitively complex procedural task
that involves rule-­based learning, and examined the related func-
tional connectivity in motor sequence-­associated networks versus
networks associated with cognitive strategies.
Methods: Participants (n = 38) were trained on a complex procedural
task, the Tower of Hanoi (ToH), while undergoing functional Magnetic
Resonance Imaging (fMRI). The ToH involves motor sequence move-
ments, but also requires the acquisition of a novel cognitive strategy in
order to solve the puzzle. After either a full night of sleep (n = 19) or a
full day of wakefulness (n = 19), participants were retested on the same
task in the fMRI. Resting state activity was acquired before and after
the training session, and also before the retest session.
Results: Performance on the ToH was better following sleep compared
to wake (t(36) = 2.23, p = 0.032). Next, we targeted seed regions as-
sociated with fine motor movements and cognitive complexity (i.e.,
the caudate), and regions typically implicated in sequence learning (i.e.,
the putamen). Compared to the wake condition, the sleep condition
showed increased connectivity between the caudate and the motor
cortex (t(36) = 3.32, p = 0.042, FWE), from immediately after the train-
ing session to immediately before the retest session (i.e., across the
retention interval filled with either sleep or wake). Functional connec-
tivity was not observed when using the putamen as a seed region.
Conclusions: These results suggest that sleep enhances functional
connectivity in brain areas that support cognitively complex motor
skills and results in enhanced problem-­solving skills.
Disclosure: Nothing to disclose.
P174 | Age-­related changes in sleep impact
learning-­related functional connectivity in the
cortico-­striatal-­hippocampal system
Z. Fang1; D. Smith1; G. Albouy2; B. King2; C. Vien3; H.
Benali4; J. Carrier3,5; J. Doyon6,7,8; S. Fogel1,9,10
1 P175 | Rhynchophylline, an inhibitor of the
School of Psychology, University of Ottawa, Ottawa, ON, Canada;
2
Department of Movement Sciences, KU Leuven, Leuven, Belgium;
3
Department of Psychology, University of Montreal, Montreal, QC,
Canada; 4Functional Neuroimaging Laboratory, INSERM, Paris,
France; 5Centre for Advanced Research in Sleep Medicine, Hôpital du
6 1
Sacré-­Coeur de Montreal; McConnell Brain Imaging Centre, Montreal
7
Neurological Institute; Department of Neurology and Neurosurgery,
Montreal Neurological Institute, McGill University; 8Functional
Neuroimaging Unit, University of Montreal, Montreal, QC; 9Sleep
10
Unit, The Royal's Institute of Mental Health Research; University
of Ottawa Brain and Mind Research Institute, University of Ottawa,
Ottawa, ON, Canada
Objectives/Introduction: Motor sequence learning (MSL) and sub-
sequent consolidation depend on the cortico-­striatal-­hippocampal
network. Sleep, in particular, facilitates consolidation of MSL, re-
flected by changes in activation within these networks. However,
this benefit of sleep is preferentially observed in the young. Sleep
has also been shown to strengthen learning-­
related functional
connectivity (FC) during rest within cortico-­
striatal-­
hippocampal
networks in the young, with the putamen as a hub. Yet, it remains
unclear whether sleep also modulates FC patterns in older adults.
Methods: Groups of young (20–35 years, n = 28) and older adults (55–
75 years, n = 30) performed a 5-­item explicit MSL task in the MRI scan-
ner at 11:00am, immediately followed by a resting-­state scan (RS1).
Participants were then randomly assigned to either the Nap (n = 13
young; n = 15 older) or No‐Nap (n = 15 young; n = 14 older) condition
for a 90‐min retention interval at 1:00PM. The second MRI session
took place at 4:00PM and included a resting state scan (RS2) imme-
diately followed by the MSL task. An ROI-­to-­ROI approach based on
previously established cortico-­striatal-­hippocampal network was used
to examine age differences in pre vs. post-­nap FC after MSL.
Results: Young, but not older adults showed sleep-­dependent changes
in FC within the cortico-­striatal-­hippocampal network (pFDR < 0.05)
and in offline gains in MSL performance. Specifically, this age by sleep
condition interaction was driven by enhanced FC in young nap vs.
wake, between the putamen hub region and motor cortical regions
(pFDR < 0.05). By contrast, the older nap vs. wake groups showed sig-
nificantly reduced FC between caudate and precuneus, and reduced
FC between the striatum and hippocampus (pFDR < 0.05). There were
no age or sleep-­related changes in cortico-­cortico FC.
Conclusions: Young subjects showed an enhancement of learning-­
related FC within the cortico-­
striatal-­
hippocampal network.
However, older adults did not show this increase in FC. By contrast,
older adults that slept showed a reduction in FC between the cau-
date and precuneus, and between the striatum and hippocampus.
Together, these results suggest the benefit that sleep provides for
enhanced communication between brain areas that support motor
memory consolidation is lost with age.
Disclosure: Nothing to disclose.
EphA4 receptor, causes modifications in sleep
architecture in mice
M.N. Ballester Roig1,2; T. Leduc1,2; V. Mongrain1,2
Université de Montréal; 2Center for Advanced Research in Sleep
Medicine, Recherche CIUSSS-­NIM, Montreal, QC, Canada
Objectives/Introduction: EphA4 is a cell adhesion molecule in-
volved in neurotransmission. It notably modulates spine retraction,
receptors at the synapse and neuron-­glia communication. It is ex-
pressed in the cerebral cortex, hippocampus and suprachiasmatic
nucleus. Interestingly, EphA4 knockout mice (KO) have alterations in
sleep including decreased REM sleep in the light phase and shorter
duration of non-­
rapid eye movement (NREM) sleep slow waves.
ABSTRACTS
However, it remains to be defined whether these changes originate
from neurodevelopmental effects or from a role of EphA4 in neu-
ronal function. We hypothesize that repressing EphA4 in adult mice
will replicate effects observed in EphA4 KO mice.
Methods: The electroencephalogram (EEG) was recorded in
C57BL/6J mice receiving the EphA4 inhibitor Rhynchophylline (RHY).
RHY 50 mg/kg (n = 5), 100 mg/kg (n = 6) or saline (n = 7) was injected
intraperitoneally at light onset (ZT0) and 1 h before light offset
(ZT11). Effects on sleep architecture and EEG activity are investi-
gated together with sex differences. After the injection day, brains
were sampled to examine protein and gene expression in the cortex,
thalamus, hippocampus and striatum.
Results: RHY-­
100 mg/kg decreases the time spent in rapid eye
movement (REM) sleep during the light phase and decreases the
time spent in wakefulness during the dark phase (Group-­by-­Hour
interaction: F46,345≥1,7; p ≤ 0.02). In addition, both RHY doses pro-
duced a fragmentation of wakefulness and NREM sleep during the
light phase (more individual bouts of shorter duration) (Main Group
effect: F2,15≥5,0; p ≤ 0.02). EEG spectral analysis revealed that RHY-­
100 mg/kg increases activity in slow frequencies in wake (Group-­by-­
Frequency interaction: F232,1740≥3,4; p < 0.0001) and modifies the
time-­course of NREM delta and sigma activity (Group-­by-­Interval
interaction: F34,255≥2,2; p < 0.04). Sex-­dependent variations and the
impact of RHY on EphA4 downstream effectors (e.g., glutamate re-
ceptors, glial glutamate transporter 1) are now being examined.
Conclusions: This research indicates that the EphA4 inhibitor RHY
modifies sleep in a way that resembles the phenotypes found in
EphA4 KO mice. This supports a role of EphA4 in the regulation of
wakefulness and sleep duration and quality. Nevertheless, effects
of RHY differing from previous KO experiments (like the increased
fragmentation) may suggest EphA4-­independent effects of RHY.
Our findings increase the understanding of molecular pathways con-
tributing to sleep regulation.
Disclosure: Nothing to disclose.
P176 | Effects of sleep timing and regularity on
endogenous phase of melatonin
1,2 2 3
E.B. Klerman ; M.A. St. Hilaire ; C.J. Hilditch ; S.A.
Rahman2
1 ceived research funding from Seoul Semiconductor Co Funding:
Neurology, MGH/ Harvard Medical School; 2Medicine, Div. Sleep
and Circadian Disorders, Brigham and Women's Hospital, Boston, MA;
3 R01HL128538, P01AG009975, R21HD086392.
Fatigue Countermeasures Lab, NASA Ames Research Center, San Jose
State University Research Foundation, Moffet Field, CA, United States
Objectives/Introduction: Many individuals have later bed and wake
times and more frequent naps on non-­work/non-­school days vs.
work/school days. We (Phillips et al., Scientific Reports 2017), and
others have found correlations between irregular sleep/wake sched-
ules and later circadian timing, and poorer outcomes for mood,
academic performance, weight, and psychiatric disorders. A causal
|
      157 of 356
link, however, between sleep regularity and these outcomes has not
been established. In the current study, we tested the effects of sleep
regularity, independent of sleep duration, on endogenous circadian
phase as measured using Dim Light Melatonin Onset (DLMO).
Methods: Healthy volunteers aged 18–35 y were enrolled in an inpa-
tient 26-­day study that included light exposure (duration and inten-
sity) and sleep schedules derived from students residing on campus
during the academic year. Three types of schedules were tested in
the current study: ‘early’ regular (ER), ‘late’ regular (LR) and ‘irregular’
(IR) with average sleep onset times of ~23:50, ~3:00 and ~2:50, re-
spectively. The average sleep duration for all was ~7.5 h/ 24 h.
Blood samples were collected under dim light (< 3 lux) at the be-
ginning and end of the inpatient study and assayed for melatonin,
from which DLMO was calculated. Phase angle of entrainment was
defined as the difference between final DLMO and average sleep
onset. Differences among the three conditions were assessed using
ANOVA.
Results: Data are available from 25 participants (9F; 8 ER, 9 LR, 8
IR). There was no significant difference in pre-­study sleep timing or
duration between the groups.
Groups differed significantly in the change in DLMO between end
and beginning of study (p = 0.019). The ER group showed an average
(± SD), advance in DLMO of 0.3 (1.5) h, while the LR and IR schedules
delayed by 2.9 (2.3) and 4.2 (4.4) h, respectively. There was no sig-
nificant DLMO change difference between LR and IR, or in the phase
angle of entrainment between groups.
Conclusions: There is no difference in average DLMO change or
phase angle between individuals on LR and IR schedules, likely due
to similar on-­average later bedtimes in both conditions. Our results
have implications for understanding sleep regularity on circadian
entrainment.
Disclosure: EBK (2018-­present) has received travel support from the
Sleep Research Society, the National Sleep Foundation; The World
Conference of Chronobiology, the Gordon Research Conferences,
and the Santa Fe Institute. She received payment from the Puerto
Rico Trust for a grant review. MSH (2018-­present) has received
travel support/honoraria from the American Academy of Neurology
and the Providence Sleep Research Interest Group. She received
payment from The MathWorks for limited consulting and from the
Fonds de la Recherche Scientifique for a grant review. SAR (2018)
has provided paid consulting services to, Bambu Vault LLC and re-
NIH Grants K24HL105664, R01HL114088, R01GM105018,
 |
158 of 356       ABSTRACTS
P177 | Non-­REM sleep network connectivity
represents an altered, not a reduced state of
consciousness
E. Houldin1,2; Z. Fang3; L. Ray3; B. Stojanoski2; A. Owen2;
S. Fogel3
1 2
University of Queensland, Brisbane, QLD, Australia; Western
University, London; 3University of Ottawa, Ottawa, ON, Canada
Objectives/Introduction: Reduced conscious awareness is associ-
ated with reduced resting state network (RSN) functional connec-
tivity (FC), particularly for ‘higher-­order’ RSNs (e.g., default mode
network), which are also associated with executive cognition. RSN
FC can therefore serve to profile consciousness and higher-­order
cognition. However, sleep RSN FC is poorly understood, due to lim-
ited fMRI data for rapid eye movement (REM) and slow wave sleep
(SWS); stages accompanied by dramatic brain electrophysiology
changes. It remains to be fully determined how these changes are
reflected in RSN FC, and, by association, higher-­order cognitive ac-
tivity and consciousness.
Methods: Simultaneous electroencephalography-­
functional mag-
netic resonance imaging (EEG-­fMRI) was recorded from 36 non-­
sleep-­deprived sleeping subjects. RSN FC matrices were generated
for 14 canonical RSNs, for NREM2, SWS, REM and wake, with poly-
nomials fit to FC edge data across all stages. It was hypothesized that
quadratics would best-­fit most edges, indicating progressive devia-
tion from wakefulness FC during NREM, and a return during REM.
Angular distances determined dissimilarity between sleep stages
and wakefulness. NREM FC was tested for; reductions, increases, or
reversed polarity of wakefulness FC.
Results: Consistent with our hypothesis, the majority (36/42) of the
subset of FC edges significantly (p < 0.05) modulated by sleep were
best described by quadratics. Changes were highly directional; pri-
marily (27/36) towards opposite connectivity in NREM and towards
wake connectivity in REM, with many (18/27) edges reversing polar-
ity in NREM. Angular distances suggest whole-­brain RSN FC changes
reflect this pattern, with FC driven furthest from wake during SWS
(p < 0.001) and closest to wake during REM (not significant); this held
for subset edges involving RSNs associated with higher-­order cogni-
tion and consciousness. Finally, most (34/55) significant (p < 0.05)
RSN FC stage transitions between wakefulness and NREM comprise
either increases, or reversals, rather than reductions of FC.
Conclusions: We demonstrated for the first time that RSN FC fluctu-
ates according to changes in electrophysiology across wakefulness
and sleep. Further, NREM progressively modulates RSN FC opposite
wakefulness, implying wakefulness/NREM homeostatic function.
Significantly, angular distance results and the more nuanced stage
transition analysis suggest NREM manifests not merely a reduced,
but an altered state involving higher-­order brain areas implicated in
cognition and conscious awareness.
Disclosure: Nothing to disclose.
P178 | Greater cortical thickness in the
occipital cortex is associated with larger
slow wave amplitude and stronger cortical
involvement in centro-­frontal brain areas
G. Avvenuti1; J. Cataldi2; A. Leo3; L. Cecchetti1; A. Lutti4; B.
Draganski4; F. Siclari2; G. Bernardi1
1
Momilab, IMT School for Advanced Studies Lucca, Lucca,
Italy; 2Center for Investigation and Research on Sleep, Lausanne
University Hospital, Lausanne, Switzerland; 3Department of
Translational Research and Advanced Technologies in Medicine and
Surgery, University of Pisa, Pisa, Italy; 4Laboratory for Research in
Neuroimaging LREN, Department of Clinical Neurosciences, Lausanne
University Hospital, Lausanne, Switzerland
Objectives/Introduction: The slow waves (0.5–2 Hz) of NREM-­sleep
synchronize locally across close neuronal populations and propagate
toward distant brain regions through cortico-­cortical pathways. In
this light, several slow-­wave properties are commonly assumed to
reflect specific micro-­and macro-­structural brain features. Using
fMRI-­
EEG we recently showed that sleep slow waves especially
engage somatomotor, visual, insular and parahippocampal cortices
(Betta et al., in preparation). Thus, here we investigated whether
anatomical properties of these regions of interest (ROIs) are related
with slow-­wave characteristics.
Methods: Twenty-­t wo healthy adults (31.7 ± 9.0y, 14F) completed
an overnight high-­
density (hd-­
)EEG recording (256 electrodes,
500 Hz;11.30PM–6.30AM) and an MRI session in the morning, after
sleep (3T; 8AM–9AM). High-­resolution MPRAGE T1w-­images were
analyzed using Freesurfer and the mean cortical thickness (CT) was
computed in the four bilateral ROIs. The hd-­EEG recordings were
preprocessed to reduce possible artifacts and slow waves were au-
tomatically detected in the first 30 min of NREM-­sleep. A partial
correlation analysis was performed to investigate the possible rela-
tionship between CT in each ROI and median slow wave amplitude,
including total cortical grey matter volume, age and gender as covari-
ates of no interest. Permutation-­based approaches were used to test
for statistical significance and to correct for multiple comparisons.
Results: A significant correlation between cortical thickness and me-
dian slow wave amplitude was found only in the cuneus (r = 0.60,
corrected p = 0.02). In line with this, we also found a positive corre-
lation between cuneus CT and slow wave topographic involvement
of central-­lateral and frontal electrodes (pone-tail< 0.05, cluster-­based
correction). Moreover, by measuring mean slow-­
wave propaga-
tion latency in a frontal (around Fz) and in an occipital (around Oz)
group of electrodes, we found a significant correlation between cu-
neus CT and shorter propagation delay only in the posterior cluster
(r = −0.50, p = 0.029).
Conclusions: The present results indicate that structural properties
of the visual cortex predict the degree of slow-­wave synchroniza-
tion in centro-­frontal areas and suggest that this relationship could
be mediated by an increased efficiency in slow-­wave propagation
ABSTRACTS
through/from the visual cortex toward more anterior areas. Future
studies should investigate whether differences in occipital CT may
have direct implications for the restorative effects of sleep and/or
for the efficiency of sensory disconnection.
Disclosure: Nothing to disclose.
P179 | Within-­night comparison of auditory
stimulation modalities on efficacy to enhance
slow wave activity across cortical regions
S. Huwiler; S. Huwyler; L. Kiener; C. Lustenberger
D-­HEST, ETH Zürich, Neural Control of Movement Lab, Zürich,
Switzerland
Objectives/Introduction: Non-­rapid eye movement (NREM) sleep is
associated with many favorable effects on brain and body functions
and to elucidate its causal role, non-­invasive brain stimulation ap-
proaches to modulate the slow waves, which hallmark deep NREM
sleep, have gained popular interest. Particularly auditory stimulation
is a promising approach for which two stimulation protocols have
been repeatedly used: (1) pink-­noise bursts presented during each
up-­phase of a slow wave (up-­phase stimulation) (2) targeting the first
up-­phase of a slow wave followed by a continuous, rhythmic 1-­Hz
stimulation (e.g. pink-­noise bursts with fixed inter-­stimulus interval
of ~1s). Both protocols have been shown to successfully enhance
slow wave amplitude during NREM sleep. However, within-­night
comparisons between the two protocols have not been performed
yet.
Methods: We investigated the global effects of various stimulation
modalities on slow wave activity (SWA, 0.5–4.5 Hz) in 23 healthy
male participants (age 22–59 years) within one single nocturnal sleep
period using high-­density EEG. The stimulations or sham were de-
livered in blocks of 10 seconds (ON windows) directly followed by a
pause of 10 seconds (OFF windows) that were repeated throughout
detected NREM sleep. For this analysis, we are comparing up-­phase
stimulation and 1-­Hz stimulation with sham (no stimulation).
Results: The assessment of the mean SWA measured in a frontal
electrode (Fz) per subject using a linear mixed model approach (con-
dition entered as fixed factor, subject as random factor, Bonferroni-­
corrected) revealed a significant increase (p < 0.001) in SWA
between the 1-­Hz condition (mean SWA: 91.52 μV2/Hz) compared
with sham (mean SWA: 47.82 μV2/Hz) and a significant increase in
SWA (p < 0.001) for the up-­stimulation (mean SWA: 81.45 μV2/Hz)
compared with sham. There was no significant difference in SWA
between 1-­Hz and up-­phase stimulation (p = 0.38). Additionally, a
slow wave enhancing effect of both stimulations in central, parietal,
and occipital electrodes (all p < 0.001) compared to sham was found.
Conclusions: Our findings suggest the first evidence that both
rhythmic 1-­Hz stimulation and up-­phase targeted stimulation may
have comparable increasing effects on SWA compared to sham.
Disclosure: Nothing to disclose.
|
      159 of 356
P180 | Validation against PSG of an
Ambulatory Circadian Monitoring (ACM)
procedure for the estimation of sleep in children
B. Rodriguez-Morilla1,2; G. del-Rio3,4; L. García3; T. Gómez3,5;
M. Campos2; M.A. Rol2; M.J. Martínez1,2; J.A. Madrid1,2
1
Kronohealth SL; 2Chronobiology Lab, University of Murcia (UM). IMIB-­
Arrixaca, Murcia; 3Multidisciplinary Sleep Unit, Hospital Universitario
Fundación Jiménez-­Díaz (FJD); 4Paediatric Service, Hospital
Universitario Fundación Jiménez-­Díaz; 5Neumology Service, Hospital
Universitario Fundación Jiménez-­Díaz (FJD), Madrid, Spain
Objectives/Introduction: Wearable devices are increasingly expand-
ing due to their low intrusiveness, ecological validity, and usefulness
for the challenges of telemedicine. The ACM procedure (Kronowise®
-­Kronohealth SL -­combined with TAPL-­Keywake® algorithm), was
previously validated to estimate sleep in adults1. This study aimed to
validate ACM against PSG to determine sleep timing, quantity, and
quality in children.
Methods: The sleep of 31 patients (14 girls, age 2–12), attend-
ing to the Sleep Unit of the University Hospital FJD, was simulta-
neously assessed by overnight PSG and Kronowise placed at the
non-­dominant hand. The fifteen variables sampled by Kronowise,
including temperature, tilt, acceleration, and circadian (blue), visible
and infrared light, were stored in 30″ epochs. TAPL algorithm2, nor-
malizing and integrating temperature, acceleration, position, and vis-
ible light, was used to automatically identify the main sleep periods.
The Keywake® algorithm based on TIM (time in movement) was used
to detect awakenings>= 30′′. These calculations are implemented on
the Kronowizard platform (https://krono​wizard.um.es/, UM). PSG-­
MCA sensitivity (sleep agreement), specificity (wake agreement), ac-
curacy, F1 score and Matthews Correlation Coefficient (MCC) were
determined, and sleep outcomes compared through Pearson corre-
lation and ANOVAs for time in bed (TIB), sleep latency (SL), total
sleep time (TST), sleep efficiency (SE), number of awakenings (NA),
and wake after sleep onset (WASO).
Results: The ACM procedure was accurate to estimate the main
sleep parameters in children, as demonstrated by: (a) the lack of sig-
nificant differences (p > 0.1) between PSG and ACM in the estima-
tion of TIB, TST, NA and SE; (b) the significant correlation between
PSG and ACM estimations (p < 0.05); (c) the low bias in the ACM esti-
mates, and (d) the high MCC (0.6), remarkably high sensibility (0.95),
accuracy (0.92) and F1 score (0.93), and substantial specificity (0.68).
Conclusions: Our results support the reliability of the ACM proce-
dure to measure sleep timing, quantity, and quality in children. This
entails great possibilities for sleep telemedicine and, together with
big data analyses, allows epidemiological studies and clinical screen-
ings in large paediatric populations.
Disclosure: Nothing to disclose.
 |
160 of 356       ABSTRACTS
P181 | Factors involved in success with
myofunctional therapy to treat sleep disordered
breathing based on a telemedicine mHealth
application
C. O'Connor-Reina1; J.M. Ignacio-Garcia2; E. Rodriguez
Ruiz3; M.T. Garcia Iriarte 4; J.C. Casado Morente5; G. Plaza
Mayor6; P. Baptista Jardin7
1
Otolarynogology Department, Hospital Quironsalud Marbella &
Campo de Gibraltar, Marbella; 2Neumology Department, Hospital
Quironsalud Marbella & Campo de Gibraltar; 3Neumology Department,
Hospital Quiron Salud Marbella, Marbellla; 4Otorhinolaryngology
Department, Hospital La Merced, Osuna; 5Otorhinolaryngology
Department, Hospital Quironsalud Marbella & Campo de Gibraltar,
Marbella; 6Otorhinolaryngology Department, Hospital La Zarzuela,
Madrid; 7Otorhinolaryngology Department, Clinica Universitaria de
Navarra, Pamplona, Spain
Objectives/Introduction: Myofunctional therapy (MT) has become
one of the therapeutical options to treat sleep-­disordered breathing
(SDB). Its main problem is the low adherence of the patients that
is approximately 10% in the majority of investigations. We present
our experience with MT based on a mHealth Application www.airwa​
ygym.
Methods: Patients with OSA who rejected CPAP and other thera-
peutical options were selected for the study. Our protocol included
complete ENT examination with detail for Friedman scale, tongue tie
presence (Hazelbaker′s scale), tongue strength measurements with
IOPI (Iowa Oral Performance Instrument), Body mass index (BMI)
and Apnea -­Hypopnea Index (AHI) scores were collected. Patients
were instructed to perform exercises under an App guidance.
Telemedicine allowed the physician to retrieve information about
adherence and accuracy of the performance of the exercises by the
patient. Patients were checked monthly for three months, with re-
peated IOPI measurements.
Results: Fifty-­four patients were enrolled between November 2018
till April 2020. Thirty-­
five patients (64.8%) performed exercises
five times a week, 15 minutes a day (90 sessions). Demographics:28
males and 7 females with an average age of 45.9 ± 17,8 years.
Friedman stage: Stage I: 4 patients (11.4%), Stage II: 11 patients
(31.45%), Stage III: 14 patients (40%) and Stage IV: 6 patients (17%).
A change in AHI was observed from 32.97 ± 12.8 to 21.9 ± 14.5
(T = 6.360 p < 0.05), also in IOPI measures from 44.4 ± 11.08 to
49.66  ±  10.2 (T  =  −3.8 p < 0.05), Sat O2 min change 80.91 ± 6.1
to 85.09 ± 5.3 p < 0.05). BMI values were: pre 25.81 to IMC post
25.1 Kg/m². IOPI scores were correlated significantly with AHI post
exercise scores (Pearson = 0.4 p = 0.01). Tongue-­tie scores had a
significant correlation with scores obtained in IOPI and AHI (Partial
correlation = 0.441 p = 0.009). BMI was correlated with the final AHI
(Pearson = 0.3 p = 0.08). There was no relationship with AHI and
Friedman stage seen (p = 0.39).
Conclusions: In our experience, MT based on telemedicine has good
adherence, and its effect on AHI is correlated with IOPI, BMI, and
Hazelbaker′s scores. No relationship with the Friedman stage was
seen.
Disclosure: Dr C O'Connor Reina and Dra Mt Garcia-­Iriarte are the
authors of the M health Airway-­Gym Rest of authors no disclosure.
P182 | Comparison of night to night variation
of the home sleep polygraphic examination
R. Rozgonyi; N. Kovács; B. Faludi
Department of Neurology, University of Pécs, Pécs, Hungary
Objectives/Introduction: Diagnosis and effective treatment of
obstructive sleep apnea syndrome (OSA) in adults is an important
health priority. Home respiratory polygraphy is a cost-­effective al-
ternative to polysomnography in OSA suspected patients. Little is
known about the night to night variability of the examination.
The purpose of this study was to investigate the intraindividual
variability of two consecutive home respiratory polygraphic exami-
nations by comparing the severity characteristics and pattern (eg.
supine, supine dominant, continuous, etc.) variability.
Methods: We examined 100 patients with clinically suspected OSA.
The participants underwent home respiratory polygraphy on two
consecutive nights. All polygraphic examinations were manually vali-
dated according to the AASM rules. The relationships of time in bed
(TIB), apnoe-­hypopnoe index (AHI), oxygen desaturation index (ODI)
and T90 of the two examinations were compared by Pearson test.
The ranks of severity and nightly apnea pattern of the two periods
were compared by Spearman and Wilcoxon test.
Results: The Pearson correlation showed strong association in case
of AHI and ODI in severe cases (n = 36, 0.7947 and 0.8465 respec-
tively, p < 0.001), while the correlation was only moderate for ODI
(n:27, 0.4696, p < 0.0135) in moderate group. Wilcoxon test of the
two night's severity ranks and patterns showed the absence of sig-
nificant differences with the highest value in the common moder-
ate and severe groups (n:63, p > 0.05 for each). Spearman rank test
showed strong correlation in moderate and severe group together
(n:63, 0.65, p < .0001), while in the mild and negative group together
the correlation was only moderate (n = 37, 0.456, p < 0.0001). The
Spearman correlation of patterns of examinations showed strong
correlation in every group. Number of severity rank changes be-
tween the two examinations was the highest in moderate group (11
form 27), followed by the mild category (7 from 29).
Conclusions: Our results revealed good intraindividual correlation
in case of severe disease. The low correlation and high number of
severity rank changes in other severity groups underline the impor-
tance of repetition of the examination for the exact disease severity.
Change of the phasic characteristic can explain the discrepancy of
pattern type stability and change of severity.
Disclosure: Nothing to disclose.
ABSTRACTS
P183 | Sex-­related differences in young
obstructive sleep apnea (OSA) patients: cross-­
sectional data from the European Sleep Apnea
Database (ESADA)
G. Conti1; O. Marrone2; P. Steiropoulos3; O. Basoglu4; O.
Ludka5; W. Randerath6; W. McNicholas7; J. Hedner8; L.
Grote8; M. Bonsignore1,2; On behalf of the ESADA Study
Group
1
PROMISE, University of Palermo; 2IRIB-­CNR, Palermo, Italy;
3
University General Hospital, Democritus University of Thrace,
Alexandroupolis; 4Department of Chest Diseases, Ege University
Faculty of Medicine, Izmir, Greece; 51st Department of Internal
Cardio-­angiology, St. Anne′s University Hospital, Brno, Czech Republic;
6
Centre of Sleep Medicine and Respiratory Care, University of Cologne,
Bethanien Hospital, Solingen, Germany; 7Department of Respiratory
and Sleep Medicine, University College Dublin, Dublin, Ireland;
8
Department of Sleep Medicine, Sahlgrenska University Hospital,
Gothenburg, Sweden
Objectives/Introduction: The features of OSA in young adults are
poorly defined. Anthropometrics, OSA severity and comorbidities,
as well as the interrelationships among age, sex and degree of obe-
sity in young OSA patients were analyzed and compared with those
in an older sample.
Methods: We retrospectively analyzed ESADA data obtained at di-
agnosis for the age ranges: 18–<30 (n = 1248), 30–< 40 (n = 3490)
and ≥ 40 years (n = 24,750), stratified according to sex, BMI (< 25,
≥25–< 30, ≥30–< 35, ≥35–< 40, and ≥ 40 kg/m2), OSA severity (no
OSA, mild OSA, moderate-­severe OSA) and occurrence of daytime
sleepiness (ESS ≥ 10). Prevalence of comorbidities was also recorded.
Results: Totally 29,488 patients (29.8% females) were included.
Patients < 40 yrs accounted for 16% of the total sample (n = 4738,
21% females). Mean body mass index (BMI) gradually increased with
age in both sexes ((age18– < 30 years: F 29.3 ± 10.0 vs M 29.8 ± 7.4,
age30– < 40 years: F 32.6 ± 9.3 vs M 31.3 ± 6.6, and age ≥ 40 years: F
32.5 ± 7.8 vs M 31.6 ± 5.9, p < 0.001 for age, gender, and age-­gender
interaction by ANOVA), while waist and neck circumference were
higher in males than females in all age groups. Young women showed
the highest prevalence of no OSA (age 18– < 40 years: F 59.1% vs
M 28.1%, and age  ≥  40  years: F 21.6% vs M 10.5%, p < 0.0001).
Prevalence of moderate-­severe OSA was higher in males than fe-
males (age18– < 40: F 23% vs M 51%; age  ≥  40  years: F 55.5% vs
M 72.8%, p < 0.0001). Prevalence of mild OSA was approximately
20% across age groups in both sexes. In moderate-­to-­severe OSA,
males showed a similar BMI distribution in all age groups, with a peak
at BMI 25–35 kg/m2, whereas young females showed a peak 40%
prevalence of BMI > 40 kg/m2 (p < 0.0001). Young females were
sleepier and had a higher prevalence of type 2 diabetes and psychi-
atric disease than young males.
|
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Conclusions: OSA in young women more frequently appears to be
driven by obesity and metabolic abnormalities, while the pattern in
young males is similar to that observed in older age groups.
Funding of ESADA: ERS, ResMed, Respironics and Bayer.
Disclosure: Nothing to disclose.
P184 | Clinical judgement in mild OSA patients
from the European Sleep Apnoea Database
(ESADA) study
I. Bouloukaki1; M.R. Bonsignore2; L. Grote3; W.T.
McNicholas4; J. Hedner3; J. Verbraecken5; S. Ryan4; C.
Lombardi6; O.K. Basoglu7; A. Pataka8; S. Mihaicuta9; M.
Drummond10; W. Randerath11; S. Bailly12; J.-L. Pepin12; P.
Steiropoulos13; S.E. Schiza1
1
Sleep Disorders Center, Department of Respiratory Medicine,
University of Crete, Heraklion, Greece; 2PROMISE, University of
Palermo, Palermo, Italy; 3Department of Sleep Medicine, Sahlgrenska
University Hospital, Sahlgrenska Academy, Gothenburg University,
Gothenburg, Sweden; 4Department of Respiratory and Sleep Medicine,
St. Vincent's University Hospital, School of Medicine, University
College, Dublin, Ireland, Dublin, Ireland; 5Antwerp University Hospital,
Faculty of Medicine and Health Sciences, University of Antwerp,
Antwerp, Belgium; 6Department of Medicine and Surgery, University
of Milano-­Bicocca, Milan, Italy; 7Department of Chest Diseases,
Ege University Faculty of Medicine, Izmir, Turkey; 8Department
of Respiratory Medicine, Respiratory Failure Unit, G.Papanikolaou
Hospital, Medical School, Aristotle University of Thessaloniki,
Thessaloniki, Greece; 9Department of Pulmonology, ‘Victor Babeş’
University of Medicine and Pharmacy Timişoara, Timişoara, Romania;
10
Pulmonology Department Hospital São João, Medicine Faculty of
11
Porto University, Porto, Portugal; Bethanien Hospital, Institute
of Pneumology at the University of Cologne, Solingen, Germany;
12
University Grenoble Alpes, INSERM HP2 U1042 and Grenoble
13
University Hospital, Grenoble, France; Sleep Unit, Department of
Pneumonology, Democritus University of Thrace, Alexandroupolis,
Greece
Objectives/Introduction: Mild obstructive sleep apnoea (OSA) is
highly prevalent but the clinical significance remains uncertain. The
Clinical Global Impression Severity (CGI-­
S) Scale has been used
as a complementary tool to assess global disease severity. Our
study aimed to evaluate if the CGI-­S is a useful tool to assess dis-
ease severity in patients with mild OSA and to predict treatment
recommendations.
Methods: Non-­apnoeic snorers (n = 2112) and mild OSA patients
(n = 2248) from the European Sleep Apnoea Database (ESADA)
cohort were evaluated and compared according to CGI-­S scores,
which is a 7-­point scale ranging from 1 (normal) to 7 (extremely ill)
transformed to four severity categories: Normal (score = 1), mild
(score = 2–3), moderate (score = 4) and severe (score = 5–7).
 |
162 of 356       ABSTRACTS
Results: Mild OSA patients’ CGI-­S score was significantly higher
compared to non-­a pnoeic snorers (19% vs 11% were scored ≥ 4,
p < 0.001). Moreover, non-­a pnoeic snorers were more frequently
rated in the ‘normal’ category than mild OSA patients (57% vs
17%, p < 0.001). Independent predictors for a high CGI-­S score
were age > 60 years [odds ratio-­O R (95% CI) 1.497 (1.181–1.897),
p  =  0.001], ESS score  >  10 [OR (95% CI) 2.055 (1.674–2.523),
p  <  0.001], coronary artery disease [OR (95% CI) 1.385 (1.109–
1.728), p  =  0.004], type-­2 diabetes [OR (95% CI) 1.940 (1.433–
2.628), p  <  0.001], chronic obstructive pulmonary disease [OR
(95% CI) 2.834 (2.041–3.934), p < 0.001], psychiatric disease [OR
(95% CI) 1.376 (1.021–1.855), p = 0.036] and AHI > 10 event/h
[OR (95% CI) 2.571 (1.900–3.477), p < 0.001]. Additionally, high
CGI-­S score (≥4) strongly predicted PAP treatment recommenda-
tion [OR (95% CI) 4.121 (1.863–9.116), p < 0.001].
Conclusions: Our results suggest that CGI-­S could be a useful tool for
OSA disease severity assessment in mild OSA patients. Furthermore,
integrating comorbidities and daytime function CGI-­S could poten-
tially serve as an add-­on parameter on treatment decision.
Disclosure: Nothing to disclose.
P185 | Maintenance of wakefulness test: how
does it predict accident risk in patients with sleep
disorders?
P. Philip1,2,3; K. Guichard1,2,3; M. Strauss4,5,6; D. Léger6,7;
E. Pepin6,7; I. Arnulf8; P. Sagaspe1,2,3; L. Barateau9,10; R.
Lopez9,10; J. Taillard1,2,3; J.-A. Micoulaud-Franchi1,2,3; Y.
Dauvilliers9,10
1
Sommeil, Addiction et Neuropsychiatrie, USR 3413, Université de
Bordeaux; 2CNRS, SANPSY, USR 3413; 3CHU Bordeaux, Centre
Hypersomnies Rares, Bordeaux, France; 4Neuropsychology and
Functional Imaging Research Group, Center for Research in Cognition
and Neurosciences; 5Department of Neurology and Psychiatry, Erasme
Hospital, Cliniques Universitaires de Bruxelles, Université Libre de
Bruxelles, Brussels, Belgium; 6Université de Paris, VIFASOM (Vigilance,
Fatigue, Sommeil et Santé Publique), EA 7330; 7APHP, Hôtel-­Dieu
de Paris, Centre du Sommeil et de la Vigilance; 8Sleep Disorder Unit,
Pitié-­Salpêtrière University Hospital (APHP), Paris; 9Reference National
10
Center for Narcolepsy, Sleep Unit, CHU Montpellier; PSNREC, Univ
Montpellier, INSERM, Montpellier, France
Objectives/Introduction: To determine whether the objective level
of alertness measured by the Maintenance of Wakefulness Test
(MWT) is associated with the occurrence of self-­reported sleepiness-­
related traffic near misses and accidents related to sleepiness in pa-
tients with sleep disorders.
Methods: This case-­control study was conducted over a three-­year
period in four French sleep centers during a 4*40 min MWT in pa-
tients driving more than 5000 Km/year. Relationship between mean
sleep latency on the MWT (MWT latency) and age, sex, driving,
sleepiness-­related near misses and accidents reported during the
previous year, and sleep disorder characteristics was analyzed.
Results: Of 377 patients suffering from OSAS, idiopathic hyper-
somnia, narcolepsy, restless leg syndrome or insufficient sleep syn-
drome, 176 were included. 74 cases reported an accident or near
miss related to sleepiness at the wheel in the past year, and 102 re-
ported no accident/near miss (control patients).
Thirty-­one (37.8%) cases and 9 (8.8%) controls reported being sleepy
at the wheel more than once a week (p < 0.0001). After adjusted
regression analyses, patients with MWT latency between 19 and
33 minutes had a 3.2-­ (CI 95%[1.5; 6.8], p < 0.0001) fold increase in
risk of reporting a near miss/ accident and patients with MWT la-
tency < 19 min had a 5.5-­ (CI 95%[2.2; 13.8], p ¼ 0.003) fold increase
in this risk, compared to the referent group (MWT latency > 33 min).
Conclusions: MWT latency is associated with self-­
reported,
sleepiness-­related near misses and accidents related to sleepiness in
the past year in patients routinely investigated in sleep clinics. The
MWT could be used to assess driving risk together with clinical in-
terviews assessing sleepiness at the wheel.
Disclosure: Nothing to disclose.
P186 | Ambulatory EEG-­measured sleep
associated with attention-­deficit/hyperactivity
disorder symptom severity among adolescents
J. Lunsford-Avery; S. Kollins; C. Keller; M. Engelhard
Duke University Medical Center, Durham, NC, United States
Objectives/Introduction: Sleep disturbances are prevalent in ADHD;
however, little is known about sleep and ADHD in adolescence, a
period characterized by shifts in sleep behavior and physiology.
Additionally, although sleep may be integrally tied to ADHD, sleep
is rarely adequately assessed in psychiatric care settings, partly due
to cost, inconvenience, and/or inaccessibility associated with objec-
tive assessments (e.g., polysomnography). This study is the first to
examine associations between sleep and ADHD among adolescents
using self-­administered, at-­home sleep-­EEG.
Methods: Ninety adolescents (mean age = 14.34, 49% female, 37%
minority race/ethnicity, 24% ADHD) completed 7 nights of sleep-­
EEG (via Zmachine Insight+) and a self-­report of ADHD severity
(Youth Self Report; YSR). Parents/guardians reported adolescents’
psychiatric diagnosis history. Sleep-­EEG was self-­administered by
adolescents each evening before bed and removed upon waking.
Regressions covarying for age, sex, and race/ethnicity examined (1)
associations between sleep-­EEG (averaged total sleep time (TST), ef-
ficiency (SE), wake after sleep onset (WASO), sleep-­onset latency
(SOL), deep sleep, rapid eye movements (REM), time spent out of bed
(TSOB)) and ADHD severity in the full sample and (2) group differ-
ences in sleep-­EEG between adolescents with and without ADHD.
Results: Lower SE (F(4,85) = 4.26, p = 0.04) and greater SOL
(F(4,85) = 7.27, p = 0.01) and TSOB (F(4,85) = 10.58, p = 0.002) were
ABSTRACTS
associated with increased ADHD severity. In addition, reduced deep
sleep trended toward an association with greater ADHD severity
(F(4,85) = 2.99, p = 0.09). TST, WASO, and REM were not associated
with ADHD severity (p's> 0.10). Adolescents with ADHD displayed
reduced SE (F(4, 85) = 4.49, p = 0.04) and greater SOL (F(4,85) = 4.08,
p < 0.05), compared to adolescents without ADHD. No other group
differences were observed (p's> .05).
Conclusions: Specific sleep-­EEG indices (decreased SE, increased
SOL) are associated with ADHD severity and diagnosis among ado-
lescents using self-­administered, at-­home sleep-­EEG. Results sug-
gest that sleep may play a role in adolescent ADHD, or alternatively,
ADHD symptoms may contribute to sleep difficulties. Findings also
suggest that self-­administered sleep-­EEG may be a useful tool for
assessing ADHD-­related sleep difficulties in routine health care set-
tings. Future studies may assess whether interventions targeting SE
and SOL (e.g., cognitive-­behavioral therapy for insomnia) may im-
prove ADHD outcomes among adolescents.
Disclosure: Nothing to disclose.
P187 | A re-­examination of the antidepressant
effects of sleep deprivation in major depressive
disorder under highly controlled conditions
J. Goldschmied1; P. Gunter1; E. Boland1; H. Barilla1; H. Rao2;
D. Dinges1; N. Goel3; J. Detre2; M. Basner1; Y. Sheline1; M.
Thase1; P. Gehrman1
1
Psychiatry; 2Neurology, University of Pennsylvania, Philadelphia, PA;
3
Psychiatry & Behavioral Sciences, Rush University Medical Center,
Chicago, IL, United States
Objectives/Introduction: Numerous studies including a recent
meta-­analysis from our group have shown that sleep deprivation
rapidly improves depressive symptoms in 50% of individuals with
major depressive disorder (MDD). Because the mechanisms under-
lying this antidepressant effect have important implications for the
development of novel interventions, we investigated this effect and
its neural underpinnings utilizing a more highly controlled approach
than is typical of studies of this phenomenon.
Methods: 36 individuals with MDD who were free of antidepressant
medication and 10 healthy controls (HC) completed a 5 day/4 night
protocol consisting of adaptation, baseline, total sleep deprivation
(TSD), and recovery phases. Light was kept at a constant, dim light
level (lux< =50), meals were regulated, and activity was restricted. In-­
the-­moment mood was assessed using a modified Hamilton Rating
Scale for Depression (HAM-­D), and recorded at the screening visit,
and in the morning following the experimental nights.
Results: Mean ± SD HAM-­D scores from the MDD group were
16.89 ± 6.16, 8.27 ± 5.10, 8.24 ± 4.34, and 5.50 ± 3.72 following
screening, baseline, TSD, and recovery, respectively. Results from
repeated measures ANOVA with group as a between-­subjects fac-
tor revealed a significant Time x Group interaction (F(3,42) = 11.65,
|
      163 of 356
p < 0.001), and significant main effects of group (F(1,44) = 41.77,
p < 0.001), and time (F(3,42) = 13.97, p < 0.001). As expected, those
in the MDD group had higher scores on the HAM-­D than those in the
HC group, and the day of the study had a significant effect on mood
in both groups. Post-­hoc analyses revealed that these significant ef-
fects were attributed to mood improvement in the MDD group fol-
lowing study initiation prior to beginning TSD, and in the HC group
following recovery sleep, but were not due to mood improvement in
the MDD group during TSD.
Conclusions: Our results revealed that individuals with moderate
MDD can experience a significant reduction in depressive symptoms
upon entering the laboratory environment where light, food, activ-
ity, social interaction are highly controlled. No further improvement
in mood occurred during 36 hours of TSD. Our findings indicate that
environmental effects on mood can be substantial and need to be
considered in studies examining the antidepressant effects of sleep
deprivation.
Disclosure: Nothing to disclose.
P188 | Increased fronto-­parietal theta
asymmetry during REM sleep may be associated
to insomnia: an EEG study
T. Provencher1; S. Fecteau2,3; C.H. Bastien1,2
1
School of Psychology, Laval University; 2CERVO Brain Research
Center, Centre Intégré Universitaire en Santé et Services Sociaux de la
Capitale-­Nationale; 3Faculty of Medicine, Laval University, Quebec,
QC, Canada
Objectives/Introduction: Individuals with insomnia (INS) have been
shown to present instabilities in REM sleep, known to possibly in-
terfere with basic processes such as emotional regulation, sleep
perception or memory. Because these processes are underpinned
by cortical networks, REM sleep disruption can be accompanied by
perceptible changes in electroencephalographic (EEG) brain activ-
ity. Such alterations, usually absent in good sleepers (GS), may be
measured as variations in brain connectivity, including changes in
EEG asymmetry. Thus, the objective of this study was to evaluate
and quantify patterns of asymmetry between frontal, central, pari-
etal and occipital derivations in GS and INS. We aimed to assess the
association between these asymmetry patterns and sleep misper-
ception, as well as the severity of insomnia and daytime anxious and
depressive symptoms.
Methods: To assess patterns of asymmetry, standard EEG was recorded
in 62 right-­handed individuals (43 INS; 19 GS) for three nights in a sleep
laboratory. Intrahemispheric asymmetry measures were based on EEG
power spectral analysis (0–60 Hz) computed between pairs of regions
at fronto-­central, fronto-­parietal, fronto-­occipital, centro-­parietal,
centro-­occipital and parieto-­occipital derivations. Differences between
groups were assessed with repeated-­measures ANOVAs. Correlations
were then performed on asymmetry and sleep misperception, as well
 |
164 of 356       ABSTRACTS
as self-­reported daytime anxiety and depressive symptoms, and insom-
nia severity. Significance levels were set at p < 0.05.
Results: Compared to GS, INS presented increased theta (4–8 Hz)
asymmetry in the left hemisphere between frontal (F3) and parietal
(P3) derivations, but only during REM sleep, F(1, 62) = 7.95, p = 0.006.
Activity was 42% higher at F3 in INS, but only 6% in GS. This pat-
tern of asymmetry was negatively associated with total sleep time
misperception in GS, r = −0.324, p < 0.05. Associations were found
with depressive and insomnia complaints, positive in INS (r= {0.182,
0.205}), and negative in GS (r= {−0.559, −0.406}).
Conclusions: Because an association with insomnia symptoms lies
within this fronto-­
parietal pattern of asymmetry, these findings
suggest it may serve as a distinctive cortical biomarker of insomnia.
According to our data, we might ask if brain stimulation applied on
these regions may reduce both their pattern of asymmetry and their
resulting diurnal symptoms.
Disclosure: Nothing to disclose.
P189 | Effects of cognitive behavioral therapy
for insomnia on objective and subjective sleep
quality during benzodiazepine withdrawal among
older adults with chronic insomnia
L. Barbaux1,2; N. Cross1,2; J.-L. Zhao1,2; C. Desrosiers2; M.
Essouni2; A. Guimond2; D. Clerc2; F. Andriamampionona2; C.
Tannenbaum2; J.-P. Gouin3; T.T. Dang-Vu1,2
1
Department of Health, Kinesiology and Applied Physiology, Concordia
University; 2Centre de Recherche de l'Institut Universitaire de Gériatrie
3
de Montréal, Montreal; Department of Psychology, Concordia
University, Montréal, QC, Canada
Objectives/Introduction: Chronic insomnia affects up to 20% of
older adults. Benzodiazepines and benzodiazepine receptor agonists
are commonly prescribed hypnotics for insomnia. Their long-­term
use is associated with cognitive side effects. Therefore, withdrawal
is encouraged in older individuals. Cognitive behavioral therapy for
insomnia (CBT-­I) is the recommended first-­line treatment for chronic
insomnia. The aim of this study is to investigate the effect of CBT-­I
on sleep quality during benzodiazepine withdrawal in older individu-
als with chronic insomnia.
Methods: 41 participants (69.06 ± 6.88 y.o; 31 females) with chronic
insomnia and chronic use of benzodiazepines or benzodiazepine re-
ceptor agonists (15.04 ± 12.48 yrs) completed polysomnography as-
sessment (for: total sleep time (TST), wake after sleep onset (WASO),
sleep onset latency (SOL), sleep efficiency (SE)), sleep diaries (self-­
reported TST, WASO, SOL, SE) and questionnaires (insomnia sever-
ity index, ISI). Participants were randomized into 2 groups: CBT-­I and
Waitlist (WL). The CBT-­I group (N = 23, 71.74 ± 7.05 y.o; 17 females)
was assigned a 16-­week withdrawal program during which 8 CBT-­I
sessions were administered by a licensed psychologist. The WL group
(N = 18, 66.4 ± 5.48 y.o; 14 females) was assigned a similar weaning
program without CBT-­I, and served as a control group. Sleep assess-
ments were repeated after the withdrawal program in both groups.
The effect of CBT-­I on sleep quality within and between groups was
tested using a repeated measures ANOVA, controlling for age.
Results: 65.2% of CBT-­I participants achieved complete withdrawal
compared to 55.5% of WL. There was no significant main effects
of group or time on any of the sleep variables. However, there was
a significant interaction between group and time for self-­reported
WASO (F = 5.38; p = 0.01) and SE (F = 3.3; p = 0.049), with CBT-­I
improving more over time than WL (WASO: −7.5 ± 19 min. in CBT-­I,
+13.8 ± 19.3 min. in WL, t = 3.14, p = 0.004; SE: +5.7 ± 8.5% in CBT-­I,
-­ 3.5 ± 13.2% in WL, t = −2.26, p = 0.03).
Conclusions: These preliminary findings show that CBT-­
I during
withdrawal from benzodiazepines in older chronic insomniacs im-
proves self-­reported sleep quality. Our findings support the use
of CBT-­I during the tapering of hypnotics in older individuals with
chronic insomnia.
Disclosure: Nothing to disclose.
P190 | Sleep spindles as a potential interictal
biomarker of the epileptogenic zone in drug-­
resistant focal epilepsy
V. Latreille1; J.-M. Lina2; L. Peter-Derex1,3; J. Corbin-
Lapointe2; P. Klimes1; B. Frauscher1
1
McGill University; 2Department of Electrical Engineering, École de
Technologies Supérieures, Montreal, QC, Canada; 3Centre Hospitalier
Universitaire de Lyon, Lyon, France
Objectives/Introduction: Sleep rhythms mirror healthy brain net-
works. Studying these sleep rhythms in neurological conditions such
as epilepsy can inform about the underlying brain network altera-
tions and may be a promising avenue to identify the seizure-­onset
zone in focal epilepsy, which may ultimately benefit surgery plan-
ning. Here we aimed to determine whether alteration of intracer-
ebral sleep spindles could serve as a useful interictal biomarker for
the epileptogenic zone in patients with drug-­resistant focal epilepsy.
Methods: Thirty-­
two patients who underwent combined scalp-­
intracranial stereo-­electroencephalographic (SEEG) recordings from
2010–2019 at the Montreal Neurological Institute were selected.
Sleep spindles and epileptic spikes were detected automatically in in-
tracranial channels from 10 minutes of interictal non-­rapid-­eye move-
ment sleep stages N2 and N3 of the first sleep cycle. For each patient,
SEEG electrodes were grouped into three zones: seizure-­onset zone
(SOZ), exclusively irritative zone (IZ), and normal zone (NoZ; absence
of abnormal slowing, and no or rare spikes). Spindle characteristics
[rate (n/min), frequency, duration] as well as spike rate (n/min) were
computed and then normalized by the number of channels for each
zone. Normalized spindles and spikes were then compared between
the three zones using repeated measures analyses of variance.
Correlation analyses were performed between spindle and spike rates.
ABSTRACTS
Results: Spindle rates were significantly reduced in the SOZ (mean
number per channel ± SD, 0.28 ± 0.27) as compared to both IZ
(0.50 ± 0.31, p = 0.02) and NoZ (0.82 ± 0.59; p = 0.0001). The IZ also
had significantly less spindles than the NoZ (p = 0.0004). Spindles
were of shorter duration within the SOZ (0.58 ± 0.16) as compared
to IZ (0.66 ± 0.06, p = 0.02) and NoZ (0.67 ± 0.07; p = 0.002). No sig-
nificant differences were found for spindle frequency. As expected,
spike rates were higher in the SOZ (13.87 ± 15.00) relative to the IZ
(3.16 ± 1.79; p < 0.0001) and NoZ (1.37 ± 1.87; p < 0.0001). Spindle
and spike rates were negatively correlated (r  =  −0.47, p < 0.0001),
with higher spiking being associated with reduced spindles.
Conclusions: Sleep spindles, as one example for a physiological
rhythm, are affected by interictal epileptic activity. Investigation of
these rhythms might serve as a potential useful marker of the epilep-
togenic zone in focal epilepsy, complementing the existing biomarkers.
Disclosure: The authors report no conflict of interest. Funding was
provided by the Institutes of Health Research and the Fonds de
Recherche du Québec-­Santé to B. Frauscher.
P191 | Impact of the COVID-­19 epidemic on
dream features in the Italian population
O. De Rosa1; F. Conte1; N. Cellini2,3,4; S. Malloggi5; A.
Coppola1; M. Cerasuolo1; F. Giganti5; G. Ficca1
1
Department of Psychology, University of Campania -­Luigi Vanvitelli,
Caserta; 2Department of General Psychology; 3Department of
Biomedical Sciences; 4Padova Neuroscience Center, University of
Padova, Padova; 5Department NEUROFARBA, University of Florence,
Firenze, Italy
Objectives/Introduction: The public health emergency related to
the COVID-­19 epidemic has massively struck the Italian territory
from the beginning of March until May 2020, with most of the popu-
lation forced to home confinement for 2 months. The emergency
itself and the substantial changes in daily routines have had a sig-
nificant psychological impact as well as adverse effects on sleep
habits and quality (Cellini et al., 2020). Here we aimed to investigate
whether and how dream characteristics were also affected.
Methods: A sample of 1622 participants aged 18 to 79 years (mean
age = 34.1 ± 13.6y; 1171 F) completed an online survey from 04/01
to 04/20 2020. The several questionnaires administered through
the survey included the Pittsburgh Sleep Quality Index and a set
of specific ad hoc questions on dream features (frequency, length,
vividness, emotional tone, relation of content to the current health
emergency) and their possible changes relative to the month preced-
ing the COVID-­19 outbreak.
Results: Approximately half of the subjects reported increased or
decreased dream frequency (30.5% and 21.8%), length (27.1% and
15.8%), and vividness (31.5% and 17.1%) compared to before the
emergency. Negative dream emotionality and degree of dream
distress were significantly higher than before (p  <  0.001 for both
|
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comparisons). Current negative emotionality and distress of dreams
also showed significant positive correlations with PSQI scores
(p < 0.001 for both correlations), indicating a parallel worsening of
sleep quality and dream emotionality, and with self-­reported nega-
tive mood, stress levels and worry (p  <  0.001 for all correlations).
Moreover, 25% of the subjects reported having COVID-­19-­related
dreams and, among these, 28% reported to face, in these dreams,
problematic situations similar to those of their daily life.
Conclusions: Our data show that the COVID-­19 outbreak has signifi-
cantly affected dream features, paralleling the significant changes
observed in sleep habits and quality. In particular, the increased neg-
ative emotionality of waking life linked to the epidemic and its con-
sequences on daily routines appears to have been reflected in dream
emotionality and content, in line with the continuity hypothesis on
the relationships between dreaming and the wake state.
Disclosure: Nothing to disclose.
P192 | Critical concerns in the interpretation of
STOP and STOP-­BANG in the elderly
L. Lusic Kalcina; I. Pavlinac Dodig; S. Demirovic; R. Pecotic;
M. Valic; Z. Dogas
Split Sleep Medicine Centre, University of Split School of Medicine,
Split, Croatia
Objectives/Introduction: Considering high statistical heterogeneity
in the performance of screening questionnaires for OSA reported in
different studies, there is a need for large sample size studies. The
aim of the current study was to assess the predictive value of STOP/
STOP-­BANG in OSA suspected patients and to investigate possible
modifications of cut-­off values.
Methods: The analysis included 3128 patients aged ≥ 18 years as-
sessed in Split Sleep Medicine Center Croatia, with STOP/STOP-­
BANG questionnaires prior to polygraphy (PG) or polysomnography
(PSG). If not indicated otherwise, reported AUC values were signifi-
cant p < 0.05.
Results: According to PG/PSG, 467 had no OSA and 2661 partici-
pants had mild to severe OSA. STOP sensitivity was 86,5% with
specificity of 45,3%, whereas STOP-­BANG had a 92,4% sensitiv-
ity with specificity of 45,8%. When the analysis was performed for
patients separately in age groups above 60 (N = 1216) and below
60 years of age (N = 1912), STOP sensitivity was 86,8% and STOP-­
BANG sensitivity was 90,6% in younger respondents with corre-
sponding specificity of 48,1% and 52%. Differently, in older patients,
the STOP sensitivity was 86,2% with 32,6% specificity, and 94,9%
sensitivity for STOP-­BANG with 18,6% specificity.
As a predictor in the full sample, age achieved AUC value of 0,717
with the highest predictive value with 46 years cut-­off (based on the
Youden index) and BMI achieved AUC value of 0,764 with the high-
est predictive value of 27 BMI cut-­off, whereas neck circumference
AUC was 0,77 with 41 cm cut-­off providing the best prediction.
 |
166 of 356       ABSTRACTS
In the elderly, AUC value for age was 0,534 (p = 0.387) compared with
0,70 in the younger respondents. The AUC value for BMI was 0,654
in the elderly compared to 0,789 in younger participants. The cut-­off
value in the elderly achieved the highest Youden index at 29,5 BMI
cut-­off whereas cut-­off value 26,9 in younger respondents achieved
the best prediction. Neck circumference cut-­off 41,25 cm achieved
the highest sensitivity and specificity in the elderly (AUC = 0,678)
whereas lower value of 40,75 cm performed the best in younger
subjects (AUC = 0,798).
Conclusions: These results indicate the need for new interpreta-
tion of STOP/STOP-­BANG findings and suggest different cut-­off
values of STOP-­
BANG determination with BMI, age and neck
circumference.
Disclosure: All authors declare no conflict of interest. The study was
funded by the Croatian Science Foundation grant (TIHO2_SLEEP_
BREATH 5935). Oral or poster presentation is acceptable.
P194 | Role of slow-­wave sleep delta power
on amyloid beta deposition and cognitive
performance in a mouse model of Alzheimer's
disease
S. Kollarik1,2; C. Goncalves-Moreira2,3; D. Bimbiryte2; A.
Sethi4; C. Baumann2; D. Noain2
1 2
Neuroscience Center Zurich (ZNZ), University of Zurich; Animal
Sleep Laboratory, Neurology Department, University Hospital Zurich;
3
Neuroscience Center Zurich (ZNZ); 4Institute of Pharmaceutical
Sciences, ETH Zurich, Zurich, Switzerland
Objectives/Introduction: Evidence from murine models of
Alzheimer's disease (AD) suggests that chronic sleep induction sig-
nificantly decreases amyloid beta (Aß) accumulation in the mouse
brain. However, little is known about the effects of sleep on be-
havioral outcomes of AD in relation to reduced amyloid deposition.
Even more, to date, no studies assessed how early sleep interven-
tions should begin to be preventive, or whether late interventions
can have an impact on the progress of disease. Necessary sleep-­
treatment duration has also been overlooked.
Methods: We implanted electroencephalography/electromyogra-
phy (EEG) headsets in tg2576 mutant mice, as model of AD, and their
wild-­t ype (wt) siblings, as controls, for periodic electrophysiological
monitoring of vigilance states. We targeted young (6 months of age)
and old (11 months of age) tg2576 and wt mice with both short (2-­
weeks) and long (16-­weeks) treatment regimes. We then explored
the effects of enhanced EEG delta power via Xyrem® (SO, 300 mg/kg,
p.o., twice daily) on histopathological outcome, through Congo red
staining identifying amyloid plaques, and cognitive performance,
via forced-­
alternation T-­
maze test for assessment of working
memory.
Results: Tg2576 mice at 6 months of age (n = 10) exhibited decrease in
NREM (t(18) = 2.891, p = 0.013) and increase in wake (t(18) = −2.983,
p = 0.010) proportions compared to wt controls (n = 10). We found
a significant difference between baseline (M = 0.49, SD = 0.21)
and after treatment (M = 0.69, SD = 0.10) behavioral performance
(t(5) = −2.712, p = 0.042) in young SO-­treated tg2576 mice (n = 6),
while there was no significant difference in old subjects (n = 9).
Although a reduction is observed in amyloid burden upon SO treat-
ment, no statistical difference was yet found compared to placebo
due to momentarily low sample size (n = 3–4).
Conclusions: Both young and old tg2576 mice present significant
sleep-­wake behavior and cognitive abnormalities at baseline. Our
preliminary findings demonstrate that we enhance their cognitive
performance in association with increasing the delta power, which
is otherwise severely reduced per 24 h. Based on these results we
conclude that sleep quality has an important role in cognitive perfor-
mance in AD. Further analysis on the connection of these findings to
amyloid burden must be completed.
Disclosure: Nothing to disclose.
P195 | Napping restores hippocampal-­
dependent task performance in habitual nappers
R. Leong; N. Yu; J.L. Ong; A. Ng; S.A. Jamaluddin; N. Chee;
M. Chee
Centre for Sleep and Cognition, Yong Loo Lin School of Medicine,
National University of Singapore, Singapore, Singapore
Objectives/Introduction: Afternoon naps have been shown to ben-
efit memory. However, whether benefits vary depending on whether
one is a habitual or non-­habitual napper remains uncertain. We ad-
dressed this in a group of adolescents (15 -­19 years) by comparing
the benefits of a nap relative to wake in habitual and non-­habitual
nappers. Importantly, we also investigated whether habitual nappers
would be more adversely affected by nap restriction compared to
non-­habitual nappers.
Methods: As part of the Need for Sleep 4 and 5 studies (Lo et al.,
2019, 2020) which comprised 2 cycles of manipulation and rest,
46 participants in the Nap condition (habitual nappers [HN-­Nap]:
n = 25, non-­habitual nappers [NN-­Nap]: n = 21) took a 90 min nap
(14:00–15:30) on manipulation days while 46 participants in the
Wake condition (habitual nappers [HN-­Wake]: n = 24, non-­habitual
nappers [NN-­Wake]: n = 22) remained awake in the afternoon.
Memory tasks were administered after the nap period (16:45) and
assessed short term topographical memory, picture encoding, and
factual knowledge learning.
Results: An afternoon nap was beneficial for all three memory tasks
irrespective of nap habit (main effects of nap, Fs > 4.48, ps < 0.037).
However, we found a significant nap habit x nap group interaction on
the hippocampal-­dependent topographical memory task (F = 4.04,
p = 0.039) wherein a nap, relative to wake, benefitted habitual
nappers (HN-­Nap vs HN-­Wake: 77.56 ± 11.77 vs 64.50 ± 16.83,
t(47) = 3.16, p = 0.003) but not non-­habitual nappers (NN-­Nap vs
ABSTRACTS
NN-­Wake: 74.90 ± 14.13 vs 74.45 ± 14.39, t(41) = 0.103, p = 0.918).
Importantly, napping restored the relative decline in habitual nap-
pers’ topographical memory that was incurred when nap restricted
(HN-­Wake vs NN-­Wake: t(44) = 2.15, p = 0.038).
Conclusions: Our findings support the implementation of naps in
educational settings. Contrary to concerns that napping may be dis-
advantageous for non-­habitual nappers, we found that an afternoon
nap was beneficial for memory regardless of nap habit. Importantly,
naps may be especially beneficial for habitual nappers performing a
hippocampal-­dependent task.
Disclosure: Nothing to disclose.
P196 | Relationships between locus coeruleus
structural integrity and subjective sleep quality
across the lifespan: a 7T MRI study
M. Van Egroo1; R. Van Hooren1; L. Pagen1; H. Jacobs1,2
1
Faculty of Health, Medicine and Life Sciences, School for Mental
Health and Neuroscience, Alzheimer Centre Limburg, Maastricht
University, Maastricht, The Netherlands; 2Gordon Center for
Medical Imaging, Department of Radiology, Harvard Medical School,
Massachusetts General Hospital, Boston, MA, United States
Objectives/Introduction: The brainstem locus coeruleus (LC) is
a central nucleus of the ascending arousal system, and promotes
wakefulness through widespread projections from its noradrenergic
neurons towards the hippocampus and neocortex. Previous animal
studies have identified a critical role for LC neurons in the regulation
of wakefulness periods across the sleep-­wake cycle. Here, we asked
if the integrity of the LC structure, assessed with state-­of-­the-­art
ultra-­high field magnetic resonance imaging (MRI) methods, is linked
to subjective reports of sleep-­wake quality in humans across the
lifespan.
Methods: We used an in-­house developed 7T magnetization trans-
fer (MT) MRI sequence specifically designed to image the LC at high-­
resolution in a cohort of 61 healthy participants aged 30–85 years
(mean age = 61.8 ± 12 y; 34 women). Cluster analysis was performed
to identify sub-­portions of the LC structure based on values of nor-
malized MT signal intensity. All participants were also administered
the Groningen Sleep Quality Scale to investigate subjective sleep
quality. Supplementary items probed additional measures related
to the subjective quality of the sleep-­wake cycle, including the re-
ported number of awakenings during a typical sleep period.
Results: Cluster analysis revealed two distinct segments among the
LC structure, with one located caudally and covering around one
third of the nucleus. Generalized linear mixed models adjusted for
age and sex showed that a lower signal intensity within this cluster
of neurons was specifically linked to higher number of awakenings
during sleep (F1,57 = 5.98, p  =  0.02). Interestingly, this relationship
was opposing the expected positive association between age and
nocturnal awakenings (F1,57 = 4.32, p = 0.04). Overall sleep quality
was also negatively associated with age (F1,57 = 4.05, p = 0.05), but
|
      167 of 356
showed no significant association with LC structure (F1,57 = 0.25,
p = 0.62).
Conclusions: These findings constitute the first attempt to link high-­
resolution imaging of the LC structure and sleep-­wake organisation
in healthy individuals. The specific association with nocturnal awak-
enings is in line with animal studies and further supports the im-
portant role of LC neurons in the regulation of wakefulness periods
during sleep in humans.
Disclosure: Nothing to disclose.
P197 | Sleep in barnacle geese is strongly
affected by season and moon phase
S.J. van Hasselt1; G.J. Mekenkamp1; A.L. Vyssotski2; T.
Piersma1,3; N.C. Rattenborg4; P. Meerlo1
1
Groningen Institute for Evolutionary Life Sciences, University
of Groningen, Groningen, The Netherlands; 2Institute of
Neuroinformatics, University of Zurich, Zurich, Switzerland; 3Coastal
Systems, NIOZ Royal Netherlands Institute for Sea Research, Den
Burg, The Netherlands; 4Avian Sleep Group, Max Planck Institute for
Ornithology, Seewiesen, Germany
Objectives/Introduction: Most of what we know about sleep is
based on a few mammalian model species studied under standard
laboratory conditions. Sleep studies in non-­model organisms such
as birds are limited but would shed light on the evolution and func-
tion of sleep. Birds are an interesting taxonomic group because they
exhibit the two sleep states also known for mammals. Migratory
bird species, such as barnacle geese (Branta leucopsis), have wake-­
demanding phases over the course of a year where sleep time might
be limited (migration and reproduction). We therefore performed an
electro-­encephalogram (EEG) study in barnacle geese under semi-­
natural conditions, group-­housed in a large outdoor aviary with nat-
ural temperature and light.
Methods: A total of 13 geese were implanted with epidural elec-
trodes to record EEG activity and neck electro-­myograph (EMG)
activity using miniature dataloggers. Recordings were performed
during winter and summer. Every recording had a minimal duration
of 8 days which gave us detailed information on how sleep corre-
lated with environmental factors. To assess their sleep homeostatic
responses, in both summer and winter the geese were subjected to a
4 and 8 h sleep deprivation starting from sunset.
Results: Barnacle geese showed strong differences in sleep patterns
and sleep time between the seasons. During winter, sleep was mainly
concentrated during the night, whereas during summer the animals
became largely arrhythmic. Moreover, the geese slept 1.7 h less in
summer compared with winter (p < 0.001, n = 13). Interestingly, the
birds displayed a homeostatic sleep response to sleep deprivation
in summer but not in winter. In addition to seasonal sleep changes,
sleep was also affected by moon phase, with 2 h less sleep during full
moon and half-­moon compared with new moon (p < 0.001, n = 13).
 |
168 of 356       ABSTRACTS
Conclusions: Barnacle geese show high phenotypic flexibility in
sleep under seminatural conditions and the presence of sleep ho-
meostasis is season-­dependent. Our study indicates that environ-
mental context is a major determinant of the organization of sleep
and wakefulness.
Disclosure: Nothing to disclose.
P198 | Rapid iris movements during REM sleep
in pigeons: a new window into the sleeping brain
G. Ungurean1,2; D. Martínez-González1; P.-A. Libourel2; N.C.
Rattenborg1
1
Avian Sleep Group, Max Planck Institute for Ornithology, Seewiesen,
Germany; 2SLEEP Team, UMR 5292 CNRS/U1028 INSERM,
Neurosciences Research Center of Lyon, Bron, France
Objectives/Introduction: Like mammals, birds exhibit two types of
sleep, NREM and REM sleep. During our previous experiments with
pigeons (Columbia livia), we discovered that we could actually see
their pupil through the closed eyelid. Herein, we use this translu-
cent aspect of the eyelid to examine for the first-­time state-­related
changes in avian pupil diameter.
Methods: The hyperpallial (‘primary visual cortex’) electroencephalo-
gram, neck electromyogram, and electrooculogram were recorded in 12
adult pigeons. The electrophysiological recordings and head-­mounted
accelerometry were used to score sleep state in 1s epochs. An infra-­
red LED was fixed on the skull between the eyes to back-­illuminate the
pupil. Miniature infra-­red sensitive video sensors installed on a head-­
mounted frame simultaneously recorded both pupils. Pupil size was
measured across the 12 h dark period using a custom Matlab script.
Results: During sleep, the pupil was usually dilated, with intermit-
tent bursts of rapid (1.8 ± 0.8 s) constriction and relaxation. The
pigeons exhibited 1005.9 ± 155.7 of these constrictions which we
named rapid iris movements (RIMs). Most RIMs (85.8 ± 4.3%) oc-
curred during REM sleep, and the rest occurred during NREM sleep,
shortly after bouts of REM sleep. The EEG during REM sleep was
more desynchronized during periods with RIMs than those without.
Pharmacological experiments revealed that RIMs are mediated via
nicotinic cholinergic receptors in the iris muscles. During wakeful-
ness, pigeons constricted their pupil during courtship behavior.
Conclusions: Pupil dynamics in pigeons are different from those
in mammals. During NREM sleep, the pupil is dilated in pigeons,
whereas in cats and mice it constricts with increasing depth of NREM
sleep. During REM sleep, the pupil constricts and relaxes rapidly in
pigeons, whereas it varies around the constricted state in mice and
cats. Interestingly, pupil dynamics are also different during wakeful-
ness. During apparent aroused emotional states (e.g., courtship), birds
exhibit pupillary constrictions, whereas mammals exhibit dilations.
These differences are due (in part) to the fact that whereas mam-
malian pupillary constrictions are mediated through the contraction
of smooth iris muscles activated by muscarinic cholinergic receptors,
avian pupillary constrictions are mediated through the contraction of
striated iris muscles activated by nicotinic cholinergic receptors.
Disclosure: Nothing to disclose.
P199 | RNA-­Seq analysis of galaninergic
neurons from ventrolateral preoptic nucleus
identifies expression changes between sleep and
wake
X. Guo1; B. Keenan1; J. Zhu1; D. Sarantopoulou2; J. Lian1; R.
Galante1; G. Grant2; A. Pack1
1
Sleep Medicine; 2Institute for Translational Medicine and
Therapeutics, University of Pennsylvania, Philadelphia, PA, United
States
Objectives/Introduction: Galanin neurons in ventrolateral preoptic
nucleus (VLPO-­Gal) are sleep-­active and sleep-­promoting neurons
essential for sleep regulation. Here, we explored the transcriptional
regulation of the VLPO-­Gal neurons in sleep by comparing their
transcriptional responses between sleeping mice and those kept
awake, sacrificed at the same diurnal time. Results were compared
to a recently performed RNA-­seq study performed on the medial
prefrontal cortex (mPFC) using the same study design.
Methods: RNA-­sequencing (RNA-­seq) analysis was performed on
eGFP(+) galanin neurons isolated using laser captured microdissec-
tion (LCM) from VLPO. Fifty-­four mice were separated into 9 groups
(n = 5 to 6 per condition) corresponding to baseline (Z0; lights-­on),
sleep or sleep deprivation (SD) for 3, 6, 9, and 12 hours. Libraries were
made using SMARTer Stranded Total RNA-­seq Kit and sequencing
was done using Hi-­Seq 4000. Differentially expressed genes (DEGs)
between SD and sleep were identified using LimmaVoom package.
Functional analysis was performed using DAVID. Gene set enrich-
ment analysis was performed using Camera from the Limma package.
Results: Galanin expression in obtained LCM samples was enriched
for > 100-­fold, and astrocyte marker, Aldh1 l1 was depleted for > 70-­
fold when compared to bulk VLPO samples. Gene set enrichment
analysis utilizing data from a recent single-­cell RNA-­seq study of the
preoptic area demonstrated that our LCM samples were highly en-
riched with galanin-­expressing inhibitory neurons, but not galanin-­
expressing excitatory neurons. A total of 263 DEGs were identified
between sleep and SD in VLPO-­Gal neurons. In both mPFC and
VLPO-­
Gal, ER stress pathways are activated by wake and cold-­
inducible RNA-­binding proteins are activated by sleep. In contrast,
expression of DNA repair genes is increased in VLPO-­Gal during
wakefulness, but increased in mPFC during sleep.
Conclusions: Our study identified transcriptomic responses of the
galanin neurons VLPO during sleep and SD. Both systemic and
region-­specific differences in sleep/wake responses were identified
in VLPO. Our study expands knowledge about the transcriptional
response of a distinct group of neurons essential for sleep.
Disclosure: Nothing to disclose.
ABSTRACTS
P200 | Toward a complete taxonomy of resting
state networks across wakefulness and sleep
E. Houldin1,2; Z. Fang3; L. Ray3; A. Owen2; S. Fogel3
1
University of Queensland, Brisbane, QLD, Australia; 2Western
University, London; 3University of Ottawa, Ottawa, ON, Canada
Objectives/Introduction: Resting state networks (RSNs) have been
investigated under a wealth of different healthy and compromised
conditions. In healthy wakefulness, RSNs are commonly grouped into
ten ‘canonical’ networks, which resemble the spatial organization
of networks that support discrete cognitive functions. These same
canonical RSNs have been consistently identified in non-­healthy
or non-­wakefulness conditions, including sleep. What is surprising
is the seeming absence of additional, (i.e., non-­canonical) RSNs in
sleep, given established connections between canonical RSNs and
cognitive function in wakefulness and given that sleep is a healthy,
alternate brain mode with unique functions from wakefulness, such
as memory consolidation. However, this negative finding could be a
consequence of prior analysis methods, which searched exclusively
for canonical RSNs in sleep. The purpose of this study was to explic-
itly test the hypothesis that there are RSNs unique to sleep, beyond
the canonical set of RSNs.
Methods: 36 non-­sleep-­deprived subjects slept, as their brain activ-
ity was recorded with simultaneous electroencephalography (EEG)
and functional magnetic resonance imaging (fMRI). Independent
component analysis (ICA) was performed on both rapid eye move-
ment (REM) and non-­REM sleep stages, as well as a dataset compris-
ing all stages combined. The resulting independent components (ICs)
were compared with spatial templates of the canonical RSNs, using
spatial correlation. Potentially new RSNs were operationalized as ICs
with low spatial correlation (i.e., below r = 0.2) with the canonical set,
yet which also had spatial and temporal properties inconsistent with
known fMRI artifacts.
Results: Surprisingly, no unique RSNs were discovered in any in-
dividual sleep stage, nor in the combined sleep stage. All below-­
threshold ICs were positively identified as having either spatial or
temporal properties that were consistent with BOLD artifacts.
Conclusions: This finding has important implications for both sleep
and RSNs. It indicates that:
1. the unique functions of sleep do not require specialized RSNs;
rather they are supported by the same RSN architecture as
wakefulness,
2. the repertoire of waking canonical RSNs may constitute a com-
plete taxonomy,
3. prior sleep studies which made use of wakefulness RSNs were
warranted in doing so, despite not explicitly testing the assump-
tion that wakefulness RSNs apply to sleep.
Disclosure: Nothing to disclose.
|
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P201 | Development and validation of a sleep
apnea syndrome screening algorithm using heart
rate variability and long short-­term memory
A. Iwasaki1; C. Nakayama2; K. Hori3; K. Fujiwara2,4; Y. Sumi5;
M. Matsuo5; M. Kano2; H. Kadotani6
1
Faculty of Medicine; 2Department of Systems Science; 3Kyoto
University, Kyoto; 4Department of Material Process Engineering,
Nagoya University, Nagoya; 5Department of Psychiatry; 6Department
of Sleep and Behavioral, Shiga University of Medical Science, Otsu,
Japan
Objectives/Introduction: Sleep Apnea Syndrome (SAS) is a disease
which is characterized by frequent pauses of breathing during sleep.
Patients with SAS suffer from daytime sleepiness and are at high risk
of developing lifestyle-­related diseases. Many patients are undiag-
nosed and untreated partly because its gold standard test, polysom-
nography (PSG), is costly and unavailable in many hospitals.
Methods: We previously developed an SAS screening algorithm
using heart rate variability (HRV) and long short-­
term memory
(LSTM). Using apnea/sleep ratio (AS ratio) as an index of the disease
severity, it achieved high accuracies when applied to a small number
of samples. In this research, its performance was validated by a large
dataset.
Results: The result of applying this method to a clinical dataset
(n = 1015) demonstrated that AS ratios in the SAS patients were
higher than those of healthy subjects (p < 0.01). The algorithm dis-
criminated between severe SAS patients whose apnea hypopnea
index (AHI) is more than 30 and other subjects with an AUC of 0.93,
a sensitivity of 0.79 and a specificity of 0.90. These results were su-
perior to those using other algorithms proposed in relevant studies.
Conclusions: Our work demonstrated that the algorithm which com-
bines HRV and LSTM showed high accuracies when using a large
number of samples. The proposed method will realize a simple
screening system and will contribute to the diagnosis and treatment
of SAS.
Disclosure: KF is with Quadlytics Inc as well as Nagoya University.
KH and M.~Kano is with Quadlytics Inc as well as Kyoto University.
HK′s laboratory is supported by a donation from Fukuda Lifetech
Co., Ltd., Fukuda Life Tech Keiji Co., Ltd., Tanaka Sleep Clinic, Akita
Sleep Clinic, and Ai Ai Care Co., Ltd. to the Shiga University of
Medical Science. Other authors declare that the research was con-
ducted in the absence of any commercial or financial relationships
that could be construed as a potential conflict of interest.
 |
170 of 356       ABSTRACTS
P202 | Sleep disturbance as a mediator
between problematic internet use and college
adjustment
Y. Lee; S. Choi; D.W. Kim
Duksung Women's University, Seoul, Republic of Korea
Objectives/Introduction: Among the various factors for college ad-
aptation, if students experience problematic Internet use, their sat-
isfaction of daily life and involvement with the college will decrease
rather, resulting in an attrition or drop-­out. This study examined
sleep disturbance as a mediator in the relationships between prob-
lematic Internet use (PIU) and college adjustment.
Methods: Data were collected in the spring semester of 2018. 145
college students in a women′s university in Seoul, South Korea par-
ticipated in this study. Participants completed K-­scale (Korea scale
for Internet addiction) and one item on sleep related problem of
CES-­D (Center for Epidemiologic Studies Depression Scale) at the
beginning of the semester, and completed RSACQ (Revised Student
Adaptation to College Questionnaire) at the end of the semester.
We estimated pairwise correlation among problematic Internet use
variable, sleep related problem variable and the college life adjustment
variables. To explore the relationships among problematic Internet use,
sleep disturbances and adaptation to college, SEM (Structural Equation
Modeling) analyses were conducted using AMOS 21.
Results: There were 145 samples in this study. The results reveal
that sleep disturbance played a partial mediator role between prob-
lematic Internet use and college adjustment. The standardized
path coefficients from PIU (problematic Internet use) to college
adjustment (β  =  −0.407, p  <  0.001), from PIU to sleep disturbance
(β = .162, p < 0.05), and from sleep disturbance to college adjustment
(β = −0.248, p < 0.001) were significant.
Conclusions: This study shows that sleep disturbance mediates the
effects of PIU on adaptation to college. In the future, when develop-
ing programs to improve college adjustment and decrease problem-
atic Internet use, it should be considered to include interventions to
alleviate sleep discomfort.
Disclosure: Sleep disturbance or college adjustment or internet use
or internet addiction.
P203 | Sleep solutions for infants based
on sleep-­wake rhythms using a smartphone
application
1,2 1 1 3
A. Tange ; K. Mitsui ; T. Sasaki ; M. Hayashi ; M.
Hasegawa-Ohira4
1
Convivial Society Lab., Unicharm Corporation, Kanonji; 2The
Graduate School of Integrated Arts and Sciences; 3Graduate
School of Humanities and Social Sciences, Hiroshima University,
Higashihiroshima; 4Faculty of Education, Shiga University, Otsu, Japan
Objectives/Introduction: The regulation of sleep-­wake rhythms is
essential for good quality of sleep and the development of infants.
However, many infants, especially those under two-­months-­old and
have undeveloped circadian sleep-­wake patterns, have sleep prob-
lems such as difficulties in falling asleep and crying during nocturnal
sleep. We quantified circadian sleep-­wake patterns of infants and
examined whether advice based on this score was useful for improv-
ing the sleep of infants.
Methods: The participants were 60 pairs of healthy infants
(2.6 ± 0.3 months of age) and their mothers (30.8 ± 3.8) in a control
(30 pairs) and intervention (30 pairs) groups. During two weeks, an
actimeter (MTN-­220 revised version, KISSEI COMTEC Co., Ltd.) was
attached to the waist of all infants, and their mothers recorded the
infants′ sleep logs. The score of sleep-­wake patterns (SSWP) was
defined as the coefficient of determination of the most fitting cosine
wave of the 24-­hour cycle based on the activity level recorded by
the actimeter at 1-­minute intervals. The intervention group received
information about their children's SSWP of the first week and advice
on sleep solutions for their children for the next week based on the
SSWP, whereas mothers in the control group did not.
Results: No significant differences were observed between the groups
for SSWP in the first week, sleep duration, nocturnal waking, sleep
latency, or sleep efficiency in the second week, suggestive of no sig-
nificant intervention effects of information or advice based on SSWP.
However, SSWP was negatively correlated with standard deviations
(SDs) of the time of day for falling asleep (r = −0.302, p < 0.05), suggest-
ing that infants that are approximately two months of age with more ro-
bust circadian sleep-­wake pattern fell asleep at regular times of the day.
Conclusions: SSWP was related to the regularity of the time of fall-
ing asleep, which suggests that regulating the retiring time is cru-
cial for developing circadian sleep-­wake cycles of two-­month-­olds.
However, there were no intervention effects of information about
SSWP or advice. Therefore, further strategies that caregivers can
easily practice should be examined from the perspective of sleep
education advice.
Disclosure: Nothing to disclose.
P204 | Quantitative evaluation of the function
of the upper airway sensory fibres in patients
with obstructive sleep apnoea
Y. An1,2
1
Department of Otolaryngology Head and Neck Surgery, Guangdong
Provincial People's Hospital, Guangdong Academy of Medical Sciences;
2
Department of Otolaryngology Head and Neck Surgery, Guangdong
Provincial People's Hospital, South China University of Technology,
Guangzhou, China
Objectives/Introduction: To quantitatively evaluate the functional
integrity of sensory nerve fibres of the upper airway in patients with
obstructive sleep apnoea (OSA) using the Neurometer system.
ABSTRACTS
Methods: Thirty-­two OSA patients and 18 healthy controls were
included in the study. All participants were selected based on medi-
cal history, physical examination, and nocturnal polysomnography
(PSG) and divided into two groups. The upper airway sensory status
of participants was examined with a Neurometer current perception
threshold (CPT) system. The system was used to deliver electrical
stimulus at three different frequencies (2000 Hz, 250 Hz, and 5 Hz)
by an investigator blinded to the PSG results.
Results: There were no significant differences in the CPT values of
the hard palate between the OSA patients and controls at any of
the three stimulation frequencies. Besides, the differences in the
CPT values of the soft palate between these groups failed to show
any statistical significance at 250 Hz and 5 Hz. However, the OSA
patients showed significantly higher CPT values of the soft palate
at 2000 Hz than the age-­matched healthy controls [353.00 (267.00,
444.00) vs. 231.50 (149.75, 333.00); p = 0.007].
Conclusions: Our study revealed an impairment of 2000 Hz-­related
sensory nerve function of the soft palate among OSA patients. The
CPT test could be a useful tool for the quantitative and selective as-
sessment of the sensory nerve function in upper airway of patients
with OSA. Further research is required to evaluate the different
types of sensory nerve dysfunctions among such patients.
Disclosure: Nothing to disclose.
P205 | High altitude related sleep breathing
disorders in health subjects
Y. Duan; X. Han; R. Zhang; H. Gao; B. Ji
Sleep Medicine Division, Airforce Medical Center, Beijing, China
Objectives/Introduction: High altitude tourism is a popular activ-
ity recently. During the acute ascent to high level, individuals may
complain of difficulty initiating sleep or frequent awakenings. It is
reported that periodic breathing is an expected response in 25%
people at 2500 meters and 100% people at 4000 meters. In these
reports, central sleep breathing events are described, which are con-
sidered to be induced by hyperventilation at high altitude.
Methods: Five healthy volunteers participated in this research, in-
cluding 3 females and 2 males. The mean age is 39.67 ± 13.75 yrs.
Home sleep apnea testing(WatchPAT,Israel) was performed on each
subject at the sea level and 3500 meters, respectively. Peripheral
artery tension, snoring, SpO2, actigraphy, position and chest move-
ment were recorded during the testing. The recordings were ana-
lyzed automatically by the zzzPAT software and further corrected
manually by trained clinician. Apnea hypopnea index (AHI), central
AHI (CAHI), rapid eye movement (REM)-­AHI, oxygen desaturation
index (ODI), mean SpO2 and lowest SpO2 were reported.
Results: At sea level, AHI was 2.20 ± 1.35/h and the number was
23.04 ± 16.86/h at 3500 meters (p  =  0.044). CAHI was 0.00/h
at sea level and was 6.50 ± 13.16/h at 3500 meters (p  =  0.018).
REM-­AHI was 4.56 ± 2.44/h at sea level whereas the number was
|
      171 of 356
23.98 ± 19.82/h at 3500 meters (p = 0.018). ODI was 1.64 ± 0.84/h
at sea level and was 24.08 ± 17.23/h at high altitude (p = 0.039). The
mean SpO2 was 96.2%±0.84% at sea level and further dropped to
84.2%±2.28% at 3500 meters (p = 0.000). The lowest SpO2 was
92.2%±0.84% at sea level and descended to 73.0%±3.94% at 3500
meters (p = 0.001). Frequent periodic breathing was detected in one
subject and central respiratory events were majority (63.0%).
Conclusions: After rush entry to high altitude, AHI raised remarka-
bly, as well as CAHI, REM-­AHI and ODI. Besides, mean SpO2 and the
lowest SpO2 descended dramatically. In the five volunteers, using
15 as the cutoff of AHI, one can be diagnosed as central sleep apnea
due to high altitude periodic breathing, while two subjects can be
diagnosed as obstructive sleep apnea. These findings hint that with
acute elevation in altitude, not only central sleep apnea may arise
but also obstructive sleep apnea do.
Disclosure: This study was supported by Beijing Municipal Natural
Science Foundation of 7194322 and AKJ17J002.
P206 | Selective orexin 2 receptor agonist TAK-­
925 to treat narcolepsy: results of a randomized,
double-­blind, placebo-­controlled, multiple-­
ascending-­dose, phase 1 study in patients with
narcolepsy type 2
S.-I. Tanaka1; R. Evans2; R. Alexander2; M. Imazaki1; S.
Touno1; K. Shimizu1; J. Wu2; H. Faessel2; E. Ratti2; D.
Hartman2
1
Takeda Development Center Japan, Takeda Pharmaceutical Company
Limited, Osaka, Japan; 2Neuroscience Therapeutic Area Unit, Takeda
Pharmaceuticals International Co., Cambridge, MA, United States
Objectives/Introduction: To evaluate the safety, tolerability, phar-
macokinetics, and pharmacodynamics of multiple doses of TAK-­925
in a narcolepsy type 2 (NT2) population. NT2 is a rare disorder char-
acterized by excessive daytime sleepiness (EDS) and other associ-
ated symptoms, and normal or in some cases only partially reduced
orexin levels can be detected. Orexin 2 receptor (OX2R) agonists
have shown efficacy in enhancing wakefulness in wild-­type non-­
orexin deficient animals, and wakefulness effects were also ob-
served in a Phase 1 study of TAK-­925, an orexin 2 receptor agonist,
in sleep-­deprived healthy volunteers (HVs). We report here the re-
sults of a multiple dose study evaluating effects of TAK-­925 in a NT2
patient population (ClinicalTrials.gov identifier: NCT03748979).
Methods: Eligible NT2 subjects (aged 18 to 80 years, International
Classification of Sleep Disorders, third edition criteria) were rand-
omized (4:2) into TAK-­925 and placebo in each of two dose cohorts
(44 mg, 112 mg) where TAK-­925 was administered daily via a 9-­hour
intravenous (IV) infusion for 7 days. Subjects were required to wash
out of all therapies used for the treatment of narcolepsy prior to
baseline.
 |
172 of 356       ABSTRACTS
Results: Of 15 NT2 subjects screened, 14 (median age, 24.5 years;
female, 57%) were randomized. Daily IV infusions of TAK-­925 were
safe and well tolerated at both doses tested. TAK-­925 showed linear
pharmacokinetics and was rapidly cleared from plasma, consistent
with single-­dose pharmacokinetic data reported previously in HVs.
Given the data of both the Maintenance of Wakefulness Test and
Epworth Sleepiness Scale in NT2 subjects, the posterior probability
of increased wakefulness at both TAK-­925 dose levels tested on Day
1 and Day 7 over placebo is above 70%.
Conclusions: The results of this Phase 1 study show for the first time
that a selective OX2R agonist, TAK-­925, enhanced wakefulness and
was well tolerated in individuals with NT2. Further investigation of
OX2R agonists in NT2 is warranted.
Disclosure: Study supported by: Takeda Pharmaceutical Company.
Shin-­Ichiro Tanaka is a full-­time employee of Takeda Pharmaceutical
Company. Rebecca Evans is a full-­
time employee of Takeda
Pharmaceutical Company. Robert Alexander is a full-­time employee
of Takeda Pharmaceutical Company. Manami Imazaki is a full-­time
employee of Takeda Pharmaceutical Company. Shunsuke Touno is
a full-­
time employee of Takeda Pharmaceutical Company. Kohei
Shimizu is a full-­time employee of Takeda Pharmaceutical Company.
Jingtao Wu is a full-­
time employee of Takeda Pharmaceutical
Company. Helene Faessel is a full-­
time employee of Takeda
Pharmaceutical Company. Emiliangelo Ratti is a former employee
of Takeda Pharmaceutical Company. Deborah Hartman is a full-­time
employee of Takeda Pharmaceutical Company.
P207 | Sleep and screen exposure across the
beginning of life: deciphering the links using big-­
data analytics
1 2 3 2
M. Gradisar ; N. Barnett ; M. Kahn ; A. Glazer
1
Flinders University, Flinders University, Hackham, SA, Australia;
2 3
Nanit, New York, NY, United States; Flinders University, Adelaide, SA,
Australia
Objectives/Introduction: Evidence for the association between
screen time and insufficient sleep is bourgeoning, and recent find-
ings suggest that these associations may be more pronounced in
younger compared to older children, and for portable compared to
non-­portable devices. However, these effects have yet to be inves-
tigated within the beginning of life. Importantly, there are no data
for the relationship between screen exposure and objectively meas-
ured infant sleep. This study examined the moderating role of age
for both touchscreens’ and television's relationship with sleep, using
auto-­videosomnography within a big-­data sample of infants.
Methods: The sleep of 1,074 infants (46% girls) aged 0–18 months
was objectively assessed using computer-­vision technology (auto-­
videosomnography) in this cross-­sectional study. Sleep was addition-
ally reported by parents in an online survey, as was infant exposure
to touchscreens and television across the 24-­h day.
Results: Age significantly moderated the relationship between day-
time touchscreen exposure and sleep with a distinct pattern for
younger infants, in which screen exposure was associated with de-
creased daytime sleep (b = −0.60, SE = 0.14, p < 0.001), but with a
proposed compensatory increase in nighttime sleep consolidation
(nighttime awakenings: b = −0.03, SE = 0.01, p = 0.03). Compared to
touchscreens, television exposure was less likely to be associated
with sleep metrics, and age moderated this relationship only for day-
time and 24-­h sleep duration.
Conclusions: In young infants, a daytime-­nighttime sleep ‘trade-­
off’ emerged, suggesting that the displacement of daytime sleep by
screens may lead to greater accumulation of sleep homeostatic pres-
sure, which in turn facilitates more consolidated nighttime sleep.
Thus, while the ever-­rising ubiquity of electronic devices in young
children's lives requires caution and in some cases intervention, it is
also important to consider the possible benefits of these devices, in
order to profoundly understand the intricate relationship between
screen exposure and sleep.
Disclosure: Funding This study was supported by Nanit. Conflict
of interest statement (a) Financial disclosure: MG has served a Pro-­
Bono consultant for Nanit. NB and MK have served as consultants
for Nanit. AG was an employee of Nanit at the time of study imple-
mentation. (b) Non-­financial disclosure: none.
P208 | Children with down syndrome and sleep
disordered breathing display impairments in
ventilatory control
L.S. Siriwardhana1,2; G.M. Nixon1,2,3; M.J. Davey1,2,3; S.A.
Landry4,5; B.A. Edwards4,5; R.S.C. Horne1,2
1
Department of Paediatrics, Monash University; 2The Ritchie Centre,
Hudson Institute of Medical Research; 3Melbourne Children's Sleep
Centre, Monash Children's Hospital; 4Department of Physiology, Sleep
and Circadian Medicine Laboratory; 5School of Psychological Sciences
and Turner Institute for Brain and Mental Health, Monash University,
Melbourne, VIC, Australia
Objectives/Introduction: Obstructive sleep disordered breathing is
highly prevalent in children with Down syndrome, largely attributed
to the complex nature of the upper airway anatomical impairment in
this population. However, the poor response to standard treatments
targeting this anatomical impairment suggests the possible involve-
ment of other non-­anatomical factors such as neuromotor control of
the upper airway muscles, arousal threshold and ventilatory control
stability. Of these, ventilatory control instability (i.e. high loop gain)
is of particular interest as recently developed techniques allows its
estimation using standard polysomnography. Loop gain appears to
have important clinical utility in adults with obstructive sleep ap-
noea, particularly in predicting individual responses to treatment.
Accordingly, we aimed to investigate the role of ventilatory control
ABSTRACTS
instability in children with Down syndrome and sleep disordered
breathing.
Methods: Children (3–18 years) with Down syndrome and sleep dis-
ordered breathing (n = 14) were compared with typically develop-
ing children (n = 14) matched for age, gender and sleep disordered
breathing severity. All children underwent overnight polysomnogra-
phy. Spontaneous sighs were identified and a 180-­second analysis
window (60s pre-­sigh to 120s post-­sigh) containing flow measure-
ments and oxygen saturation were created. Loop gain, a measure of
the sensitivity of the negative feedback loop that controls ventila-
tion, was estimated by fitting a mathematical model of ventilatory
control to the post-­sigh ventilatory pattern.
Results: Loop gain was significantly higher in children with Down
syndrome compared to matched typically developing children (mean
loop gain ± standard deviation: 0.42 ± 0.12 vs 0.31 ± 0.11; p = 0.039).
While children with Down syndrome also had significantly lower
average oxygen saturation associated within each analysis win-
dow compared to typically developing children (96.9 ± 1.3% vs
98.0 ± 1.0%; p  =  0.019), loop gain was not related to polysomno-
graphic measures of hypoxia.
Conclusions: Children with Down syndrome and sleep disordered
breathing have a higher loop gain, indicating more unstable ventila-
tory control, compared to age, gender and sleep disordered breath-
ing severity matched typically developing children. This may be due
to an inherent impairment in ventilatory control in children with
Down syndrome contributing to their increased risk of sleep disor-
dered breathing which may ultimately aid adjunct/alternative treat-
ment options for this population.
Disclosure: Nothing to disclose.
P209 | Multiple sleep latency test (MSLT)
and 24 hour polysomnography (24 hr PSG) for
diagnosing pathological sleepiness in idiopathic
hypersomnia
1,2 2
M. Honda ; S. Kimura ; K. Sasaki ; M. Wada 2 2,3 2
; W. Ito
1
Sleep Disorders Project, Tokyo Metropolitan Institute of Medical
2 3
Science; Seiwa Hospital, Institute of Neuropsychiatry; Department
of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
Objectives/Introduction: ICSD-­
3 employed two definitions of
pathological sleepiness, ‘total sleep time on 24-­hour ≧ 660 minutes’,
evaluating sleep extension and ‘mean sleep latency ≦ 8 minutes on
MSLT’, evaluating sleep propensity. We performed 24 hr PSG and
PSG-­MSLT sequentially to compare differences of two aspects of
pathological sleepiness and determine the better diagnostic tool for
idiopathic hypersomnia.
Methods: Subjects were patients suspected of idiopathic hypersom-
nia visiting sleep disorders clinic in Seiwa Hospital. Forty consecu-
tive subjects were evaluated by 3 days sleep studies, unattended
24 hr PSG followed by a standard PSG and MSLT during Nov 2016
|
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and June 2019. Those with incomplete recording or other sleep
disorders were excluded. Data from 35 subjects (15 male and 20
female, 21.2 ± 6.9 years old, BMI 20.6 ± 2.5) were analyzed. The
sensitivity, specificity and accuracy of the two tests for the final di-
agnosis of idiopathic hypersomnia were calculated. In order to probe
the characteristics of two aspects of sleepiness, demographic and
PSG variables were compared for those with or without pathological
sleepiness determined by 24 hr PSG or MSLT.
Results: Pathological sleepiness was observed in 27 of 35 subjects
by 24 hr PSG and 6 by MSLT. Only 4 subjects met both criteria. Four
of 27 subjects with 24 hr PSG-­determined pathological sleepiness
showed multiple SOREMPs on MSLT, 2 were narcolepsy type 2 and
the others were without diagnosis. Twenty-­five of 35 subjects ful-
filled the ICSD-­3 criteria of idiopathic hypersomnia. The test sen-
sitivity was 92% and 12%, specificity 60% and 80%, and accuracy
83% and 34% for 24 hr PSG and MSLT, respectively. Comparison
of sleep variables on 24 hr PSG revealed shortened REM latency
(107 ± 101 min vs 309 ± 203 min, p < 0.001) as a possible marker for
those with pathological sleep extension.
Conclusions: Our results indicated the two aspects of sleepiness
(sleep extension and high sleep propensity) were fundamentally dif-
ferent and 24 hr PSG should be considered as a first-­line test for
diagnosing idiopathic hypersomnia. Four of 27 subjects with sleep
extension showed multiple SOREMPs, raising the question about
the significance of REM abnormality in those with sleep extension.
Disclosure: Nothing to disclose.
P210 | Light exposure rhythm and nocturnal
urinary melatonin excretion in mild cognitive
impairment patients
J.H. Lee1,2; S.J. Kim3; Y.J. Jung1; J.-W. Jang4; J.H. Jhoo1,2; I.B.
Suh5
1
Psychiatry, Kangwon National University Hospital; 2Psychiatry,
Kangwon National University School of Medicine, Chunchon;
3
Psychiatry, Doeun Hospital, Jincheon; 4Neurology; 5Laboratory
Medicine, Kangwon National University Hospital, Chunchon, Republic
of Korea
Objectives/Introduction: Aberrant light exposure patterns can
be associated with the increased risk of dementia in the elderly.
Particularly, light at night can suppress melatonin production, lead-
ing to disrupted circadian rhythms which may contribute to cognitive
impairment. We aimed to compare the light exposure rhythm (LER)
and urinary melatonin excretion between mild cognitive impairment
(MCI) patients and normal controls (NC).
Methods: Participants were recruited from the Dementia Clinic
at Kangwon National University Hospital and 2 Public Centers for
Dementia Care. Neurocognitive tests were administered and the di-
agnosis of MCI was made according to Petersen's criteria. Ten MCI
patients and 7 NC were selected. Actigraphy recording (Actiwatch 2;
 |
174 of 356       ABSTRACTS
Philips Respironics) at home was conducted for 5 days, and voided
urine during the following night was collected. From the actigraphy
data, the total amount and average intensity of light exposure were
obtained, and the interdaily stability (IS), intradaily variability (IV)
and relative amplitude (RA) of LER were determined using nonpara-
metric methods. The urinary concentration of 6-­sulfatoxymelatonin
(aMT6s) was measured, and its excretion amount was calculated by
multiplying the aMT6s concentration by overnight urine volume.
Results: There were no significant differences in demographic char-
acteristics between the MCI (n = 10, age = 77.9 ± 7.0 years, M:F = 5:5)
and NC (n = 7, age = 73.9 ± 4.7 years, M:F = 2:5) groups. The total
amount and average intensity of light exposure during sleep period
in the MCI group were higher than those of the NC group, even
though there were no statistical significances (p > 0.05). There were
no significant differences in IV, IS and RA for the LER between the
MCI and NC groups (p > 0.05). The concentration and excretion of
aMT6s in the MCI group were lower than those of the NC group,
even though there were no statistical significances (p > 0.05). In total
subjects (n = 17), neither the aMT6s concentration nor its excretion
amount was significantly correlated with the IS, IV and RA for the
LER (p > 0.05).
Conclusions: Although our study revealed no significant difference,
it suggested the light exposure would be greater and physiological
melatonin levels be lower during the night in MCI patients, compared
to those of NC. The relationship between the LER and physiological
melatonin level was not found.
Disclosure: Nothing to disclose.
P211 | The validity of wrist-­worn actigraphy
compared to polysomnography for detecting
sleep versus wake in the presence of
environmental road traffic and wind farm noise
G. Micic; B. Zajamsek; T. Liebich; C. Dunbar; B. Lechat;
F. Decup; N. Lovato; L. Lack; K. Hansen; A. Vakulin; P.
Catcheside
Adelaide Institute for Sleep Health, Flinders University, Adelaide, SA,
Australia
Objectives/Introduction: Wrist actigraphy provides an objective,
algorithm-­
based estimate of sleep inferred from accelerometer
counts of activity levels. It enables minimally intrusive long-­term
sleep estimates that are not practical via direct and intrusive sleep
measurements. While actigraphy shows excellent sensitivity, speci-
ficity is poor so inferences regarding sleep may be problematic,
particularly in the context of settings with the potential to promote
wake. Thus, the validity of actigraphy for estimating sleep in the
context of environmental noise remains unclear. This study aimed
to assess the validity of actigraphy versus polysomnography (PSG)
for detecting sleep and wakefulness in the presence of road traffic
and wind farm noise both in a controlled laboratory and real-­world
environmental settings.
Methods: .PSG and actigraphy data recorded in 30-­second epochs
were simultaneously measured in 22 participants’ homes (12 males,
[mean ± standard deviation] age 53.0 ± 11.9 years) located < 9 km
from wind farms on 2 consecutive nights. Data were also analysed
from 23 participants (10 males, age 25.4 ± 12.9 years) who slept in
a sleep laboratory for 2 nights (separated by 1-­week of recovery),
during which they were exposed to road traffic and wind farm noise.
Measurement agreement between actigraphy and PSG was as-
sessed using epoch-­by-­epoch and sleep parameter analyses. Primary
outcomes were sensitivity and specificity for detecting sleep (actig-
raphy vs PSG sleep) and overall accuracy in the laboratory and am-
bulatory settings
Results: Controlling for age in linear mixed models analyses, sen-
sitivity ([mean ± standard error] laboratory: 95.6% ± 0.01%, am-
bulatory: 92.9% ± 0.01%), specificity (laboratory: 44.2% ± 0.03%,
ambulatory: 19.1% ± 0.02%), precision (laboratory: 91.9% ± 0.01%,
ambulatory: 86.1% ± 0.01%) and accuracy (laboratory: 88.8% ±
0.01%, ambulatory: 81.3% ± 0.01%) were significantly different
between settings (all p < 0.03).
Conclusions: Actigraphy has high sensitivity, precision and accuracy
for detecting sleep but low specificity for detecting wakefulness
during sleep, performing better in the laboratory versus ambulatory
settings. Actigraphy is clearly a useful, more practical and lower cost
alternative than PSG for estimating sleep in the presence of environ-
mental noise when long-­term measurements are required. However,
inferences regarding sleep quality, particularly wakefulness during
sleep should be interpreted with caution.
Disclosure: Nothing to disclose.
P212 | Auditory stimulation triggered by sleep
spindle detection may enhance sleep-­related
memory consolidation
J. Choi; E. Kim; S.C. Jun
School of Electrical Engineering and Computer Science, Gwangju
Institute of Science and Technology, Gwangju, Republic of Korea
Objectives/Introduction: Slow oscillation (SO) and sleep spindle are
well-­known components of non-­rapid eye movement sleep which
are related to memory consolidation. In a previous study (https://doi.
org/10.1109/access.2019.2913457), we found significant enhance-
ment of procedural memory task performance during the nap with
spindle targeted acoustic feedback comparing to the nap without
acoustic stimulation. In this study, we added a randomized acoustic
stimulation condition as a control condition to verify the effect of
spindle target acoustic stimulation on memory consolidation.
Methods: Nine healthy male subjects were recruited for the study.
Subjects experienced an adaptation nap in the first visit, and they
proceeded to three different conditions of a nap in each of different
ABSTRACTS
days: sleep without acoustic stimulation, sleep with randomized
acoustic stimulation, and sleep with acoustic stimulation targeting
sleep spindle activity. Each condition of the nap was separated for at
least two weeks. Subjects trained the finger-­t apping task before nap
and tested the same task after the nap in order to measure perfor-
mance improvement during the nap.
Results: We applied Wilcoxon signed-­
rank test between condi-
tions, and we found marginal improvement (p-­
value = 0.074) in
boosting tapping speed during the nap with spindle targeted stim-
uli (0.0318 ± 0.01 seconds), comparing to the nap without stimuli
(0.0159 ± 0.01 seconds). Randomized acoustic stimuli during a nap
did not alter memory consolidation effect, comparing to the con-
dition of a nap without acoustic stimulation. Meanwhile, tapping
speed was improved much more during the nap with spindle tar-
geted stimuli than the nap with randomized stimuli (p-­value = 0.012).
Conclusions: We found significant improvement in tapping speed
after the nap with acoustic feedback triggered by sleep spindle de-
tection, comparing to the control condition. It may be the evidence
of memory consolidation mechanism which may be related to spin-
dle-­SO pair during sleep. Meanwhile, we found marginal improve-
ment of procedural memory consolidation in the nap with spindle
targeted stimuli, comparing to the nap without stimuli. Additional
experiments are under way to draw sound conclusion.
Disclosure: This work was supported by the National Research
Foundation of Korea under Grant NRF-­2016R1A2B4010897 and
GIST Research Institute(GRI) grant funded by the GIST in 2020.
P213 | TAK-­988, an orally available orexin
2 receptor-­selective agonist, ameliorates
narcolepsy-­like symptoms in an orexin neuron-­
ablated mouse model of narcolepsy
H. Kimura; T. Ishikawa; M. Suzuki
Takeda Pharmaceutical Company Limited, Fujisawa, Japan
Objectives/Introduction: Narcolepsy type 1 (NT1) is associated with
a loss of orexin-­producing neurons in the lateral hypothalamus. The
use of an orexin 2 receptor (OX2R) agonist may be a promising ap-
proach for the treatment of NT1. TAK-­988 is a novel, orally available
OX2R-­selective agonist with > 260-­fold selectivity against orexin 1
receptor in vitro. Oral administration of TAK-­988 promoted wakeful-
ness in wild-­t ype mice during sleep phase, but not in OX2R knockout
mice, confirming its OX2R selectivity in vivo. We report here the ef-
ficacy of TAK-­988 on narcolepsy-­like symptoms in orexin/ataxin-­3
mice, an orexin neuron-­ablated mouse model of narcolepsy.
Methods: TAK-­988 was administered orally to orexin/ataxin-­3 mice
at zeitgeber time 12, and then sleep/wakefulness states were evalu-
ated based on electroencephalogram and electromyogram measure-
ments. The fragmentation of sleep/wakefulness was assessed by
the episode number and duration of wakefulness. The number of
cataplexy-­like episodes was determined by the number of episodes
|
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of direct transition from wakefulness to rapid eye movement (REM)
sleep. Chocolate was used to increase the number of cataplexy-­like
episodes in orexin/ataxin-­3 mice.
Results: In orexin/ataxin-­
3 mice, oral administration of TAK-­
988
significantly increased total wakefulness time (p < 0.01 at 3 mg/kg,
p < 0.001 at 10 mg/kg, n = 7), accompanied by a decrease in total
non-­rapid eye movement sleep time (p < 0.01 at 3 mg/kg, p < 0.001
at 10 mg/kg) and total REM sleep time (p < 0.01 at 10 mg/kg), dur-
ing active phase. TAK-­988 also significantly decreased total episode
number of wakefulness (p < 0.01 at 3 mg/kg, p < 0.001 at 10 mg/
kg) and increased mean episode duration of wakefulness (p < 0.01
at 3 mg/kg, p < 0.001 at 10 mg/kg). Moreover, TAK-­988 significantly
suppressed cataplexy-­like episodes in orexin/ataxin-­3 mice during
active phase (p < 0.05 at 10 mg/kg, n = 7).
Conclusions: TAK-­988 significantly increased wakefulness and ame-
liorated both fragmentation of wakefulness and cataplexy-­like epi-
sodes in orexin/ataxin-­3 mice during active phase. TAK-­988 has the
potential to treat the cardinal symptoms of NT1 such as excessive
daytime sleepiness and cataplexy.
Disclosure: Nothing to disclose.
P214 | A novel, orally available orexin 2
receptor-­selective agonist with fast off-­rate,
TAK-­994, induces wake-­promoting effects in
non-­human primates
H. Kimura; T. Ishikawa; H. Hara; M. Suzuki
Takeda Pharmaceutical Company Limited, Fujisawa, Japan
Objectives/Introduction: The orexin system is a critical regulator of
sleep/wakefulness states, and the deficiency of orexin-­producing
neurons in the lateral hypothalamus is associated with narcolepsy
type 1 (NT1). Orexin peptides act on two G protein-­coupled re-
ceptors: orexin 1 receptor (OX1R) and orexin 2 receptor (OX2R).
OX2R knockout (KO) mice, but not OX1R KO mice, showed clear
narcolepsy-­like phenotypes, suggesting OX2R plays a more direct
role in the pathophysiology of NT1 compared with OX1R. Thus, an
OX2R-­selective agonist is anticipated to be a promising therapeutic
drug for NT1. Orexin tone has reported to show diurnal fluctuation.
Thus, fast off-­rate and appropriate half-­life in an OX2R selective
agonist could be particularly important features for a new treatment
for NT1. In this study, we characterized in vitro and in vivo profiles of
a novel, orally available OX2R-­selective agonist, TAK-­994.
Methods: A calcium mobilization assay in Chinese hamster ovary
(CHO) cells stably expressing human OX2R was used to assess OX2R-­
agonistic activity and evaluate positive allosteric modulator (PAM)
activity. The dissociation rate of TAK-­994 from OX2R was charac-
terized using an OX2R selective radioligand. Electroencephalogram/
electromyogram recordings with wild-­t ype (WT) mice, OX2R knock-
out (KO) mice and cynomolgus monkeys were performed during
sleep phase to evaluate TAK-­994 mediated arousal effects.
 |
176 of 356       ABSTRACTS
Results: TAK-­994 activated OX2R (EC50 value: 19 nM) in the calcium
mobilization assay and showed no PAM activity for OX2R. TAK-­994
showed fast dissociation from OX2R. Oral administration of TAK-­
994 significantly increased wakefulness time during sleep phase in
WT mice (p < 0.001 at 30 mg/kg, n = 6) and monkeys (p < 0.001 at
10 mg/kg, n = 8), but not in OX2R KO mice, confirming its OX2R
selectivity in vivo.
Conclusions: An orally available OX2R agonist with fast off-­rate,
TAK-­994, may have the potential to enhance wakefulness in indi-
viduals with narcolepsy and other hypersomnia disorders even in the
presence of normal orexin levels.
Disclosure: Nothing to disclose.
P215 | Multi-­species comparison of restfulness
in drosophila -­keep your eye on the flies
S. Omond1; J. Lesku1; V. Kellermann2
1 2
School of Life Sciences, La Trobe University, Melbourne; Monash
University, Clayton, VIC, Australia
Objectives/Introduction: Automated systems and machine-­learning
are popular tools for studying and analysing the behaviour of ani-
mals. This means that researchers are relying on technology to cor-
rectly interpret and score simple and complex behaviours, including
sleep.
Methods: We used the Drosophila Activity Monitoring System
(DAMS) and a video tracking software system to compare how well
each system scored restful flies. It is common for researchers to
characterise a sleeping fly as one that has not crossed the beam bi-
secting the DAMS tube for at least 5 minutes. Here, we tested nine
species of Drosophila, including D. melanogaster
Results: When applying this 5-­minute rule to the DAMS-­generated
data, we identified large variation in the amount of ‘sleep’. At the low
end of this spectrum, D. melanogaster was found to spend 36% of the
24-­h day asleep. At the other extreme, four species (D. sulfurigaster,
D. pseudoananassae, D. bipectinate and D. buzzatti) exceeded 90% of
‘sleep’ each day. (N = 57 -­63 per species)
Conclusions: Flies of some species did not cross the beam for days,
cautioning against the interpretation that these species are virtually
always asleep. Instead, those flies were likely active only at one end
of the tube. We are now analysing video data to test this hypothesis.
If true, then the 5-­minute rule may not be widely applicable beyond
wildtype D. melanogaster to study sleep.
Disclosure: Nothing to disclose.
P216 | Effects of age-­related alteration in pupil
size and ocular lens transmittance on differences
between melatonin suppression in primary
school children and that in middle-­aged adults
T. Eto1,2; M. Ohashi1,2; K. Nagata1; Y. Nishimura3; Y.
Motomura1; S. Higuchi1
1
Kyushu University; 2Research Fellow of the Japan Society for the
Promotion of Science, Fukuoka; 3National Institute of Occupational
Safety and Health, Kawasaki, Japan
Objectives/Introduction: Suppression of melatonin secretion dur-
ing the night is greater in primary school children than in middle-­
aged adults. Large pupil size and high ocular lens transmittance have
been suggested to be factors involved in the high level of melatonin
suppression in children, but the relationships between them have
remained unclear. In this study, we measured pupil size and lens
transmittance spectra and we investigated the effects of age-­related
ocular alteration on differences between melatonin suppression in
children and that in adults.
Methods: Nine children (9.2 ± 1.7 years old) and nine of their parents
(40.9 ± 2.7 years old) participated in this study. The experiment was
conducted for two nights in our laboratory. On the first night, the
participants spent time under a dim light condition (< 10 lx) from
18:00 until one hour after each habitual bedtime (BT + 1.0) in order
to obtain the basal melatonin secretion profile. On the second night,
the participants spent time under a dim light condition from 18:00
until 30 minutes before each habitual bedtime (BT-­0.5) and they
were exposed to LED light (300 lx, 6000 K) for 90 minutes, until
BT + 1.0. Saliva samples were collected every hour until BT-­1.0 and
every 30 minutes from BT-­1.0 until BT + 1.0. Pupil size was measured
between BT and BT + 1.0 under both conditions and lens transmit-
tance was measured during the daytime. Non-­visual perception was
calculated from results for pupil size and lens transmittance, and we
investigated the relationship between non-­
visual perception and
melatonin suppression.
Results: Non-­visual perception in children was significantly higher
than that in adults (p  =  0.006). In addition, melatonin suppression
at BT + 1.0 in children was significantly greater than that in adults
(p = 0.016). The children's relative value of non-­visual perception to
adults (mean ± SEM: 1.43 ± 0.08) was consistent with that of mela-
tonin suppression (1.52 ± 0.1). Non-­visual perception was marginally
correlated with melatonin suppression (r = 0.42, p = 0.083).
Conclusions: Our findings suggest that the age-­related difference
of melatonin suppression in children and adults can be explained by
pupil size and lens transmittance, but there may be individual differ-
ences that cannot be explained by those factors.
Disclosure: Nothing to disclose.
ABSTRACTS
P217 | An automated detection of active
muscle segments during sleep and its correlation
with apnea hypopnea index
J. Chen1; Y. Duan2; C. Peng3; S. Sun4; P. He1
1
College of Electronics and Information Engineering, Sichuan University,
Chengdu; 2Sleep Medicine Division, Airforce Medical Center, Beijing,
3
China; Center for Dynamical Biomarkers, Beth Israel Deaconess
Medical Center/Harvard Medical School, Boston, MA, United States;
4 Objectives/Introduction: Short-­term sleep loss frequently occurs
Department of Otolaryngology, Guang'anmen Hospital, China
Academy of Chinese Medical Sciences, Beijing, China
Objectives/Introduction: Polysomnography (PSG) is the con-
ventional method to evaluate sleep quality. Scoring PSG record-
ing is based on manual approach, which is a labor-­
intensive,
time-­consuming process. Chin electromyography (EMG) is an es-
sential factor in sleep stages scoring. Nevertheless, as a result of
increase sympathetic tone, EMG signal can reflect the relaxation
level. Therefore, it is possible to find an indicator of sleep quality
by measuring the category and duration of active segments in chin-­
EMG signal during sleep.
Methods: We proposed an automated method to detect active
segments in chin-­
EMG signal based on the energy changes. By
this method, we could determine the starting and ending points
of active segments and calculate durations of them. Based on the
durations, active segments in EMG signals were divided into three
categories: short segment (0.01 ≤ t ≤ 3 seconds), moderate segment
(3 < t < 15 seconds), and long segment (t ≥ 15 seconds). A testing set
was established based on the PSG database and chin-­EMG signals
were exported. The inclusion criteria were (1) age between 18 and
60, (2) successive chin-­EMG recording lasting more than 4 hours, (3)
suspected OSA patients, (4) without history or suspect neuromuscu-
lar diseases, (5) without taking sedatives.
Results: Fifty-­
four PSG recordings were included. There were
45 males and 9 females, with mean age 41.91 ± 10.29 years. The
mean Apnea Hypopnea Index (AHI) was 29.20 ± 19.90. Correlation
between AHI and total duration of segments was evaluated using
Pearson's correlation coefficient. A moderate correlation (r = 0.461)
was found between AHI and total duration of active segments
(85.06 ± 70.95 min, p  <  0.001). More specifically, a moderate
(r = 0.402), strong (r = 0.600), and poor (r = 0.323) correlation were re-
corded between AHI and total duration of short (15.69 ± 11.15 min,
p  =  0.003), moderate (29.63 ± 20.05 min, p  <  0.001), and long
(39.75 ± 50.16 min, p = 0.017) segments.
Conclusions: This automated chin-­EMG detecting method can detect
three categories of muscle activities and calculate the corresponding
durations. The durations of active segments show positive correla-
tion with AHI and may be a marker to indicate sleep disturbances.
Disclosure: This study was supported by Beijing Municipal Natural
Science Foundation (7194322).
|
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P218 | Effects of sleep restriction on the blood
pressure and heart rate variability in middle-­aged
adults
Y. Baek; S.-H. Kim; S. Lee
Future Medicine Division, Korea Institute of Oriental Medicine,
Daejeon, Republic of Korea
due to an increase in workload and changes in lifestyle. This research
observed the effects of short-­term sleep restriction and recovery
on blood pressure and Heart rate variability (HRV) in middle-­aged
adults.
Methods: This research was a before-­and-­after study design that
observed changes in blood pressure and HRV during sleep restric-
tion period and the recovery period, conducted with a four-­hour
sleep limit for two days and a five-­day normal sleep for daily life. The
procedure was approved by the Institutional review board.
Results: The participants were 55 males and 53 females, and
39.4 years old on average. After 2 days of sleep restriction, the
blood pressure was significantly lower than before the sleep restric-
tion (paired T-­test between day 1 and day 3, p < 0.05). HRV indexes
did not show any significant difference. After the 5 days of sleep
recovery, the blood pressure and the 5 min total power (TP), the
power in the high-­frequency range (HF) in HRV increased compared
to end of the sleep restriction (paired T-­test between day 3 and day
8, p < 0.05 in blood pressure, p = 0.049 in TP, p = 0.038 in HF). At
the end of the procedure, the TP was statistically significantly higher
than the baseline, but the blood pressure and the remaining HRV in-
dexes were recovered to levels before sleep restriction (paired T-­test
between day 1 and day 8, p < 0.05).
Concerning changes in the stress indicators according to the point
of time, the blood pressure and TP showed a statistically significant
difference (Repeated measure ANOVA, p < 0.05).
Conclusions: In this research, the blood pressure decreased accord-
ing to sleep restriction. This result was different from the increased
blood pressure due to short sleep time or sleep restriction seen in
previous studies. Changes in blood pressure should be identified in
more precise research that takes into account the measuring time
and the condition of the participant. TP showed an increasing trend,
which can be inferred as reflecting adaptation efforts to maintain
balance in response to change in the autonomic nervous system
caused by sleep restrictions.
Disclosure: Nothing to disclose.
 |
178 of 356       ABSTRACTS
P219 | A causal role for sleep in maintaining
high neurobehavioural performance in Australian
magpies
R.D. Johnsson1; F. Connelly1,2; J. Gaviraghi Mussoi3; K.E.
Cain3; A.L. Vyssotski4; T.C. Roth II5; J.A. Lesku1
1 2
School of Life Sciences, La Trobe University, Melbourne; University
of Melbourne, Parkville, VIC, Australia; 3University of Auckland,
Auckland, New Zealand; 4Institute of Neuroinformatics, University of
Zurich, Zurich, Austria; 5Franklin and Marshall College, Lancaster, PA,
United States
Objectives/Introduction: Sleep is thought to maintain optimal
brain functioning to support waking cognitive and behavioural de-
mands. However, little is known about sleep's role in neurobehav-
ioural performance in birds. We investigated how sleep deprivation
(SD) affects subsequent waking neurobehavioural performance in
Australian magpies (Cracticus tibicen).
Methods: Magpies (n = 9) were implanted with electrodes to record
sleep, and subjected to two treatments of extended wakefulness:
6-­h (1800–0000 h) and 12-­h (1800–0600 h) night-­time SD, com-
pared with a night of undisturbed sleep. On the post-­treatment day,
the birds were tested on a reversal learning task (criteria: 10 of 12
correct choices). We measured the latency to first choice (time to at-
tempt the task), performance (number of choices until criteria), and
success ratio (reached or did not reach criteria) on the task. Each
treatment was preceded and followed by a baseline and recovery
night of sleep, respectively. Sleep was analysed in Somnivore™.
Results: Sleep deprivation reduced non-­rapid eye movement (NREM)
and REM sleep for both the 12-­h and 6-­h treatments (p < 0.001).
Following the 12-­h SD, during the post-­treatment day, NREM sleep
increased compared to baseline (p < 0.001). In contrast, after the
6-­h SD treatment, the time spent asleep did not differ during the
post-­treatment day, but magpies increased NREM sleep slow-­wave
activity after the deprivation at night (p < 0.001).
Latency on the reversal learning task increased following 12-­h SD
compared to 6-­h SD (p = 0.049) and undisturbed sleep (p = 0.048). In
contrast, there was no difference between 6-­h SD and undisturbed
sleep. Performance did not differ between 6-­h SD and undisturbed
sleep, and following 12-­h SD only 1 magpie reached criteria. The suc-
cess ratio decreased after 12-­h SD compared to 6-­h (p = 0.046) and
undisturbed sleep (p = 0.025).
Conclusions: Magpies subjected to longer periods of sleep loss were
slower to attempt the task, less likely to perform and complete the
task, and those that did the test performed worse than better-­rested
birds. Collectively, these results indicate that sleep loss reduces neu-
robehavioural performance, in a dose-­dependent manner, in birds.
Disclosure: Nothing to disclose.
P220 | A pilot study investigating the effect
of wind farm versus road traffic noise on
electroencephalogram (EEG) spectral power
during sleep
C. Dunbar1; P. Catcheside2; A. Vakulin2; K. Hansen3; B.
Zajamsek 2; B. Lechat3; F. Decup3; T. Liebich1; L. Lack 2; G.
Micic2
1
College of Education, Psychology and Social Work; 2College of
Medicine and Public Health; 3College of Science and Engineering,
Flinders University, Bedford Park, SA, Australia
Objectives/Introduction: The effect of wind farm relative to road
traffic noise on human sleep microstructure remains unclear. To help
guide further research in this area, this pilot study sought to examine
the impact of wind farm and short-­range traffic noise (WFN and TN
respectively), at varying sound pressure levels (SPLs), on sleep elec-
troencephalography (EEG) using quantitative electroencephalogram
(qEEG) analysis.
Methods: Twenty-­
three predominantly young healthy good
sleepers (10 (41.7%) males, mean ± standard deviation (SD); age
21.6 ± 2.1 years, range 18–29) attended the sleep laboratory.
Participants were exposed to 3-­minute long WFN and TN stimuli
played at 33, 38 and 43 dB(A) in randomised order throughout the
night only during established sleep (>1 min N2 sleep or deeper).
Power spectral analysis was conducted to noise events commencing
in N2 sleep in 5-­second epochs relative to stimulus onset before and
throughout each 3-­minute noise stimulus. The resulting EEG spec-
tral power from delta to beta (0.5–4, 4–8, 8–12, 12–15, 15–32 Hz)
frequency ranges were normalised to baseline spectral power dur-
ing the 15 seconds prior to stimulus onset and log10 transformed
for each five second epoch and compared between noise types and
SPLs within-­subjects using linear mixed model analysis.
Results: Participants received (mean±SD) 3.6 ± 2.0 traffic and wind
farm noise events for each SPL that commenced in N2 sleep per
person. A significant noise type by SPL interaction was found for
beta power (15–32 Hz) (p < 0.05), where traffic noise showed larger
increases than WFN at each SPL, including 33 dB(A) (mean differ-
ence [95% CI]), 0.04 [0.02 to 0.07], 38 dB(A) 0.03 [0.01 to 0.05] and
43 dB(A) 0.08 [0.06 to 0.11] log transformed ratio measure. There
was also a significant SPL by time interaction in delta and alpha
power (p < 0.05) with greater increases immediately after noise
onset with 43 dB(A) compared to 33 dB(A) stimuli respectively,
0.25[0.13 to 0.37]; 0.18[0.10 to 0.26] log transformed ratio measure.
Conclusions: These results suggest that TN leads to significantly
greater increases in EEG beta power during stage 2 sleep compared
to WFN at the same SPL. However, further studies in larger samples
of WFN affected and unaffected individuals remain warranted.
Disclosure: Nothing to disclose.
ABSTRACTS
P221 | Changes in quality of sleep and quality
of life during pregnancy
1 1 1 2
H.E. Bae ; K.T. Kim ; K.W. Nam ; J.G. Bae ; Y.W. Cho 1 rural area. Total sleep time of weekday and weekend day are no dif-
1 2
Neurology; Obstetrics and Gynecology, Keimyung University
Dongsan Hospital, Daegu, Republic of Korea
Objectives/Introduction: The prevalence of sleep disorders in-
creases as pregnancy progresses, which affects the health of preg-
nant women, fetal health, and the outcomes of pregnancy. The aim
of this study is to evaluate the quality of sleep and life in pregnant
women in Korea.
Methods: This study is a prospective cross-­sectional, case-­control
study of pregnant women and age-­matched controls. From July to
September 2019, all participants completed a series of sleep ques-
tionnaires including Pittsburgh sleep quality index (K-­PSQI), insom-
nia severity index (K-­ISI), Epworth sleepiness scale (K-­ESS), Back's
depression inventory-­2 (K-­BDI), STOP and short-­form 36 (K-­SF-­36).
Results: A total of 422 participants consisted of 385 pregnant women
and 137 controls. Second and third trimester were 200 and 185,
respectively. K-­PSQI scores were higher in pregnant women com-
pared with the controls (7.87 ± 3.49 and 8.50 ± 3.55 vs. 5.79 ± 2.76,
p < 0.001). Total score of K-­SF-­36 was lowest in third trimester
(62.07 ± 17.72) and highest in the control group (79.41 ± 13.36).
There was no statistical difference between groups in K-­BDI.
Conclusions: This study demonstrated worsening of sleep quality
as well as life quality during pregnancy. More attention to sleep of
pregnant women is needed.
Disclosure: Nothing to disclose.
P222 | Regional difference of sleep status in
elderly population
1 2
W.-J. Kim ; J.H. Park
1 were asked to fill:
Neurology, Gangnam Severance Hosp., Yonsei University, College of
Medicine; 2Neurology, Sanggye Paik Hospital, Seoul, Republic of Korea
Objectives/Introduction: Biologically aging process change sleep
features. Also environmental difference can influence sleep status
in elderly population. Elderly population have more sleep disorder
than younger population and vulnerable to regional environment.
We study the sleep status of elderly population and compare with
regional site.
Methods: The present study used data from the nationwide, cross-­
sectional study on sleep status among elderly Koreans aged 65
to 86 years. Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep
Quality Index (PSQI) were used to classify sleepiness. Insomnia
Severity Index (ISI) was used for evaluation of insomnia symp-
toms and the Berlin Questionnaire for high risk of sleep apnea.
|
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International RLS Study Group criteria was used to get prevalence
of restless leg syndrome.
Results: We divided the region with metropolitan city, small city and
ference. ESS and PSQI score were no difference between regions.
But average of ISI score (4.3 ± 5.8; 5.7 ± 5.7: 7.2 ± 7.3 p < 0.012) and
poor sleepers whose PSQI index more than 5 were higher in rural
region (45 (36.9%): 63 (45.7%): 29 (56.9%)). Risk of obstructive sleep
apnea and prevalence of restless leg syndrome were similar in each
group.
Conclusions: This results showed in rural area poor sleeper and high
ISI are common. We try to find out the causes and proper treatments.
Disclosure: Nothing to disclose.
P223 | Characterization of insomnia phenotype
among obstructive sleep apnea patients
A. Gabryelska1; M. Sochal1; O. Weiner2; A. Owczarek1; P.
Białasiewicz1
1
Department of Sleep Medicine and Metabolic Disorders, Medical
University of Lodz, Lodz; 2Department of Sleep Medicine and
Metabolic Disorders, Medical University of Lodz, Jastków, Poland
Objectives/Introduction: Obstructive sleep apnea syndrome (OSA)
is a chronic condition characterized by recurrent pauses in breath-
ing during sleep, which cause arousals and sleep fragmentation. In
recent years, more phenotypes of OSA have been distinguished,
with one of them being associated with individuals presenting with
insomnia symptoms. Therefore, the aim of the study was to charac-
terization of insomnia phenotype of OSA.
Methods: Eighty individuals refereed to Centre for Diagnostics and
Treatment of Sleep and Respiratory Disorders (Lodz, Poland) with
presumptive OSA diagnosis, who underwent
polysomnography (PSG) were included in the study. All participants
following questionnaires: Athens Insomnia Scale (AIS), Insomnia
Severity Index (ISI),: Pittsburgh Sleep Quality Index (PSQI), Epworth
Sleepiness Scale (ESS) and Beck Depression Inventory (BDI). The
study was financed by National Science Centre, Poland (number:
2018/31/N/NZ5/03931).
Results: Based on ISI scores participants were assigned to one of
the two groups: insomnia (n = 26; 32.5%), and no insomnia (n = 54;
67.5%). No differences were observed between study groups in de-
mographic parameters including age (p = 0.769), BMI (p = 0.230) and
sex (p = 0.877). In PSG parameters, insomnia group had shorter REM
latency (129.5 vs. 95.3 minutes; p = 0.032) compared to group with-
out insomnia, while no differences were observed in apnea-­hyponea
index (AHI; 41.5 vs. 29.7; p = 0.104). In questionnaire results insom-
nia group has higher scores in PSQI (10.6 vs. 6.5; p < 0.001) and BDI
(12.9 vs. p = 0.022). Additionally, positive association between ISS
score and AHI (p = 0.023; r = 0.253) and BDI (p = 0.002; r = 0.339)
 |
180 of 356       ABSTRACTS
was observed. In regression model ISS score (R 2 = 0.115; p = 0.002)
was affected by BDI (p = 0.002), but not AHI (0.108).
Conclusions: OSA patients regardless of disease severity can suffer
from coexisting insomnia, which is associated with decreased mood
level. Therefore, it is important to screen OSA patients for insomnia
symptoms, as they may require additional treatment.
Disclosure: Nothing to disclose.
P224 | Predictors of sleep medication use
among Norwegian nurses -­a cross-­sectional
study
I. Forthun1; S. Waage1,2; S. Pallesen1,2; B.E. Moen1; B.
Bjorvatn1,2
1
University of Bergen; 2Norwegian Competence Center for Sleep
Disorders, Bergen, Norway
Objectives/Introduction: The aim of this study was to investigate
the prevalence of prescribed sleep medication use and identify pre-
dictors of such use among Norwegian nurses.
Methods: We used data from the Survey of Shift work, Sleep and
Health (SUSSH) among Norwegian nurses. The study included
2798 nurses who responded to a postal questionnaire. Predictors
included demographic variables, a measure of sleepiness (Epworth
Sleepiness Scale), symptoms of shift work disorder (SWD), insomnia
(Bergen Insomnia Scale), anxiety and depression (Hospital Anxiety
and Depression Scale) and work-­related predictors including hours
worked per week, work schedule, number of night shifts and quick
returns. A modified Poisson model was used to estimate relative risks
(RR) with 95% confidence intervals (CI) for the association between
each predictor and self-­reported use of prescribed sleep medication
the last year. We adjusted for sex, age, marital status, children living
at home, years of experience and average hours worked per week.
Results: In total, 208 (7.5%, 95% CI 6.6–8.5%) nurses reported to
have used prescribed sleep medication the last year. There was no
clear association between hours worked per week, work schedule,
and number of quick returns and sleep medication use, while the
risk was higher in nurses with more than 60 night shifts in the last
year compared to those with no night shifts (adjusted RR (aRR) 1.75,
95% CI 1.15–2.67). Sleep medication use increased with age (RR
1.06, 95% CI 1.04–1.07), was higher among single nurses compared
to nurses with partners (aRR 1.66, 95% CI 1.27–2.17) and among
nurses without children living at home (aRR 1.51, 95% CI 1.12–2.04).
Risk was also higher among nurses with SWD (aRR 2.57, 95% CI
1.93–3.41) and insomnia (aRR 4.81, 95% CI 3.30–7.04), and among
nurses with symptoms of anxiety (aRR 2.80, 95% CI 2.13–3.67) or
depression (aRR 2.70, 95% CI 1.96–3.73).
Conclusions: Hours worked per week, work schedule, and number
of quick returns did not predict prescribed sleep medication use
among nurses. A high number of night shifts, increasing age, being
single or without children living at home, having symptoms of SWD,
insomnia, anxiety and depression were all strong predictors of use.
Disclosure: Nothing to disclose.
P225 | The school schedule effect on self-­
reported sleep length of children and youth in
Spain
D. Gabaldon-Estevan1; K. Täht2
1
Sociology, University of Valencia, Valencia, Spain; 2Sociology, Tallinn
University, Tallinn, Estonia
Objectives/Introduction: School schedule is the main influence on
the organization of time in the life of children and youth. It particu-
larly influences how much time children and youth sleep (Carskadon,
1999; Klein, 2004; Meijer, 2008; Suchaut, 2009, 2012) and its influ-
ence in chronic sleep deprivation has been reported already in pre-
school children (Clara & Gomes, 2019). Sleep deprivation can have
serious consequences on health as has been extensively summarised
elsewhere (Roenneberg, 2012; Garaulet, 2017). In Spain schools and
high schools hours vary between the split [S] and the compact [C]
schedule depending on whether they provide a lunch break in be-
tween class sessions or after the class sessions (Fernández Enguita,
2002; Sintes, 2012; Gabaldón-­Estevan & Obiol-­Francés, 2017).
Methods: In this research we investigate the association between
(high) school time schedule and the self-­reported sleep duration by
analysing the Spanish Time Use Survey (INE 2002-­03). Our sample is
composed by 1366 students, both boys and girls, of between 10 and
18 years old. We estimate the school schedule during the school day
and analyse the student′s time budget and distribution over the day
to see the relationship between the distribution of the school sched-
ule with sleep length and other self-­reported activities that can be
related to sleep behaviour such as meal times, playing videogames,
watching TV/Videos or doing homework.
Results: Consistent with the review of the literature, the data show
significant (p < 0.01) differences in the time arrangement for stu-
dents depending on the type of school day organization. Being the
main differences per day between the compact school day organiza-
tion in comparison to the split (difference =[S]-­[C]): 27 less minutes
of sleeping time, 28 more minutes watching TV, videos and playing
videogames, and 22 more minutes of homework, library and study
during free time.
Conclusions: Our data also show that children and youth attending a
(high) school with compact time arrangement eat on average over an
hour later than those in the split scheme which often means eating
after 3 pm. Our data also show that in high school up to 9% of teen-
agers in the compact scheme are having a nap around 4 pm.
Disclosure: This work is financed by Generalitat Valencia
GV/2019/002 Project TIME [Time in childhood: a mapping of Spain].
ABSTRACTS
P226 | Insomnia and hypnotics in dementia
patients
J.H. Lee
Neurology, National Health Insurance Service Ilsan Hospital, Goyang-­si,
Republic of Korea
Objectives/Introduction: Many dementia patients complains insom-
nia and depressive mood, and hypnotics and antidepressants are
being prescribed. As prevalence of dementia is increasing, insomnia
and depressive mood are becoming more important.
Methods: We reviewed medical records of the patients who visited
outpatients clinic of NHIS Ilsan Hospital Dementia Center during
2019.
Results: Total 716 patients are included; Subjective Memory
Impairment (SMI): 143 patients (20%), non-­amnestic Mild Cognitive
Impairment (MCI): single domain 70 (10%), multiple domain 34 (5%),
amnestic MCI: single domain 74 (10%), multiple domain 159 (22%),
Early onset Alzheimer′s disease (AD): 9 (1%), AD 121 (17%), Vascular
dementia: 62 (9%), Mixed dementia 44 (6%).
Hypnotics and antidepressants are prescribed as follows; SMI: hyp-
notics 14 patients (10%), antidepressants 27 (19%), non-­amnestic
MCI: single domain hypnotics 9 (13%), antidepressants 12 (17%),
multiple domain hypnotics 4 (12%), antidepressants 6 (18%), amnes-
tic MCI: single domain hypnotics 10 (14%), antidepressants 16 (22%),
multiple domain hypnotics 22 (14%), antidepressants 24 (15%), Early
onset Alzheimer′s disease (AD): hypnotics 1 (11%), antidepressants
2 (22%), AD: hypnotics 10 (8%), antidepressants 36 (30%), Vascular
dementia: hypnotics 8 (13%), antidepressants 20 (32%), Mixed de-
mentia: hypnotics 4 (9%), antidepressants 17 (39%).
Conclusions: Among the outpatients of Dementia Center, MCI and
SMI are majorities and the number of MCI patients are almost half.
Depression are more prevalent in AD and Vascular dementia than
MCI and SMI, and about 22% of patients are being prescribed by
antidepressants and 11% by hypnotics.
Disclosure: Nothing to disclose.
P227 | Development of evening waking
homeostatic pressure during early adolescence
M. Gradisar1; M. Short1; C. Reynolds1; C. Richardson2; M.
Heath1; M. Kahn1; L. Lack1; M. Carskadon3
1 has shown that adolescents often experience concurrent difficulties
Flinders University, Adelaide, SA; 2University of Western Australia,
Perth, WA, Australia; 3Brown University, Providence, RI, United States
Objectives/Introduction: Process S (sleep homeostasis) forms one
of the two processes in the major theory describing sleep. The sleep
homeostat appears to develop at different stages over paediatric
development. During adolescence, a single cross-­sectional study
has shown the waking portion of the homeostat becomes saturated
|
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between Tanner stages 1/2 (11 yrs) and 4/5 (13.9 yrs) (Taylor et al.,
2005). The aim of the present study was to document when the
rapid changes in the homeostat occur in early adolescence using a
longitudinal design.
Methods: 20 good-­
sleeping adolescent boys (Tanner stage ½,
age = 10.3 ± 0.4 yrs at Wave 1) participated in the present study.
After a 1-­week sleep stabilisation period (ie, fixed sleep opportu-
nity), adolescents participated in a weekend laboratory protocol, in-
cluding (i) a fixed 10-­hr sleep opportunity (Night 1); (ii) hourly MSLTs
from 7:30 PM to 3:30 AM (Night 2) to measure the evening waking
homeostat. This protocol was repeated 4 times, at 6-­month inter-
vals, resulting in 4 waves of data.
Results: No significant ‘time of night’ x ‘wave’ interaction was found
across the study, F = 0.76, p = 0.79, indicating no meaningful change
in the waking sleep homeostat. As expected, a significant main ef-
fect for ‘time of night’ was found, F = 10.02, p < 0.001, with the first
significant decline of alertness occurring from 8:30 PM to 9:30 PM,
and a continuous decline till 1:30 AM, and a plateau of alertness
thereafter.
Conclusions: Previous cross-­sectional data suggest a change in the
evening waking homeostat between ages 11 to 14 yrs. Our study
adds to this finding by suggesting the rapid development in the ho-
meostat does not occur from 10 to 12 yrs. Thus, the change in this
important bioregulatory process likely occurs between 12 to 14 yrs,
which may coincide with the environmental stimulus of a change to
secondary school.
Disclosure: This study received funding from an Australian Research
Council Discovery Project (DP150100215). Prof Leon Lack is a
shareholder in Re-­Time Pty Ltd. All other authors declare no conflict
of interest.
P228 | Changes in objective sleep and anxiety
during a longitudinal study of pre-­adolescents
C. Reynolds1; M. Short1; C. Richardson2; M. Heath1; M.
Gradisar1
1
College of Education, Psychology & Social Work, Flinders University,
Adelaide, SA; 2Centre for Sleep Science, School of Psychological
Science, University of Western Australia, Perth, WA, Australia
Objectives/Introduction: Adolescence is a time of significant
change in sleep patterns and socio-­emotional wellbeing. Research
with sleep and anxiety, however cross-­sectional studies are unable
to determine the developmental trajectory of sleep and anxiety-­
related difficulties. Furthermore, data on objectively measured sleep
in this literature is lacking. Longitudinal methods may therefore be
able to determine whether there is a link between adolescents’ anxi-
ety and objective sleep characteristics as they develop.
Methods: The developmental changes of sleep and anxiety were
investigated in a longitudinal study of 20 early adolescents (mean
 |
182 of 356       ABSTRACTS
age = 10.3 yrs). Adolescents attended the sleep laboratory for one
weekend every 6 months for an 18-­month period. Four time points’
of data were collected (T1-­T4), during which objective sleep (poly-
somnography) and self-­reported anxiety (Spence Children's Anxiety
Scale) were measured.
Results: Sleep parameters were relatively stable over time, with
a slight increase in stage 3 sleep, F(54) = 3.6, p = 0.02. The model
for changes over time in wake after sleep onset (WASO) was near-­
significant, F(54) = 1.75, p  =  0.17, where WASO was significantly
higher at T3 compared to T1, p = 0.03. Improvements over time were
seen for separation anxiety, F(35) = 4.85, p  =  0.01, general anxi-
ety, F(36) = 5.45, p = 0.01 and the total anxiety score, F(36) = 4.34,
p  =  0.02. Although no significant interactions between changes in
anxiety and sleep over time emerged, several interesting trends were
noted. There was a significant two-­way interaction between time
and changes in sleep onset latency (SOL), F(15) = 4.44, p  =  0.053,
where pre-­adolescents who had a decrease in SOL over time also had
a decrease in separation anxiety. Similar findings emerged for gen-
eral anxiety, where those who had an increase in stage 1 and stage
3 sleep over time had a decrease in general anxiety (F(19) = 3.82,
p = 0.07 and F(21) = 4.6, p = 0.04, respectively).
Conclusions: Sleep and anxiety both change across adolescence,
and the present study adds to the field by showing small changes in
these areas occur in the pre-­adolescent period (ages 10–12 years).
Separation anxiety and general anxiety improved over time in our
cohort, and our data suggest that changes in sleep onset latency and
sleep architecture may be implicated in these changes.
Disclosures: This study was funded by an Australian Research
Council Discovery Project (DP150100215). The authors declare no
conflicts of interest.
References:
Alfano, C. A., Zakem, A. H., Costa, N. M., Taylor, L. K., & Weems,
C. F. (2009). Sleep problems and their relation to cognitive factors,
anxiety, and depressive symptoms in children and adolescents.
Depression and anxiety, 26(6), 503–512.
Rapee, R. M., Oar, E. L., Johnco, C. J., Forbes, M. K., Fardouly, J.,
Magson, N. R., & Richardson, C. E. (2019). Adolescent development
and risk for the onset of social-­emotional disorders: A review and
conceptual model. Behaviour research and therapy, 103501.
P229 | Bipolar II disorder has a higher
seasonality score compared to major depression
and bipolar I disorder
J.W. Yeom1; S. Jeon1,2; Y. Lee1,2; J.Y. Seo1,2; S. Son3; C.-H.
Cho2,4,5; Y.-M. Ahn6; S.J. Kim7; T.H. Ha8; B. Cha9; E. Moon10;
D.Y. Park11; J.H. Baek12; H.-J. Kang13; H. An3; H.-J. Lee1,2
1
Department of Psychiatry, Biomedical Science, Korea University
College of Medicine; 2Chronobiology Institute, Korea University;
3
Department of Biostatistics, Korea University College of Medicine,
Seoul; 4Department of Psychiatry, School of Medicine, Chungnam
National University, Daejeon; 5Department of Psychiatry, Chungnam
National University Sejong Hospital, Sejong; 6Department
of Psychiatry, Seoul National University College of Medicine;
7
Department of Psychiatry and Institute of Behavioral Science in
Medicine, Yonsei University College of Medicine, Seoul; 8Department
of Psychiatry, Seoul National University Bundang Hospital, Seongnam;
9
Department of Psychiatry, Gyeongsang National University College of
10
Medicine, Jinju; Department of Psychiatry, Busan National University
11
School of Medicine, Busan; Department of Psychiatry, National
12
Center for Mental Health; Department of Psychiatry, Samsung
Medical Center, Sungkyunkwan University School of Medicine, Seoul;
13
Department of Psychiatry, Chonnam National University College of
Medicine, Gwangju, Republic of Korea
Objectives/Introduction: Seasonality represents seasonal changes
in multiple domains, including mood, activity, and sleep. Seasonal af-
fective disorder (SAD) is defined as a condition of seasonal mood
changes characterized by recurrent depression in autumn or win-
ter that spontaneously remits in spring or summer. Since seasonal
changes can affect daily life, it is meaningful to look at the pattern
of seasonal changes in patients with major mood disorders and
whether there are differences in major depressive disorder (MDD),
bipolar I disorder (BDI), and bipolar II disorder (BDII).
Methods: All patients were included in the Mood Disorder Cohort
Research Consortium (MDCRC) study, a multicenter prospective
observational cohort study on early-­onset mood disorders in South
Korea. Total of 378 major mood disorder patients (138 MDD, 101
BDI, 139 BDII) and 40 healthy controls were selected for the analy-
sis. Seasonal pattern assessment questionnaire (SPAQ) was used for
evaluation of seasonality.
Results: The mean Global Seasonality Score (GSS) was as follows:
10.98 (SD 4.79) for MDD, 11.40 (SD 4.97) for BDI, 12.88 (SD 5.86)
for BDII, and 8.15 (SD 2.83) for control. When excluding those clas-
sified as summer type, the mean GSS was as follows: 10.29 (SD 4.80)
for MDD, 10.32 (SD 4.46) for BDI, 11.98 (SD 5.84) for BDII, and 7.46
(SD 2.23) for control. The percentage of subjects meeting the crite-
ria of SAD using SPAQ was the following: 26.1% in MDD, 24.8% in
BDI, 46.8% in BDII, and 7.5% in the controls. When excluding those
classified as summer type, the percentage of SAD was the following:
20.4% in MDD, 21.1% in BDI, 39.4% in BDII and 0% in the controls.
The mood disorder subjects had a significantly higher proportion of
ABSTRACTS
SAD than the control, and among the mood disorders, BDII had the
highest proportion of SAD (BDI,MDD< BDII, p < 0.001).
Conclusions: The results show high seasonality and high proportion
of SAD in early-­onset mood disorders, especially in BDII. It is an un-
expected result that MDD showed high seasonality scores compara-
ble to BDI, possibly due to the high bipolarity of early-­onset MDD.
This finding suggests that the early-­onset mood disorders, especially
BDII, have a high risk of seasonal winter depression.
Disclosure: Nothing to disclose.
P230 | The clinical significance of hepcidin as a
predictive biomarker for treatment responses in
restless legs syndrome
H.-J. Im
Neurology, Hallym University Medical Center/ Dongtan Sacred Heart
Hospital, Hwaseoung, Republic of Korea
Objectives/Introduction: Restless legs syndrome (RLS) is a common
sensory motor neurological disorder that is related to iron-­dopamine
dysregulation and immune system alteration. Hepcidin is the key
regulatory hormone of systemic iron homeostasis. We aimed to
assess the association between serum hepcidin in drug-­naive RLS
patients compared to healthy controls and to evaluate their role as
biomarkers for predicting clinical improvement after treatment with
dopamine agonist.
Methods: Non-­anemic and drug-­naive RLS patients (n = 18) and
healthy controls (n = 15) were enrolled. The serum hepcidin and iron-­
related values in serum were measured upon the first visit in both
groups and 12 weeks later after dopaminergic treatment in 12 pa-
tients. Information about sociodemographic characteristics, sleep-­
related profiles, mood, and anxiety was obtained upon the first visit
in all participants as well as after treatment in RLS patients.
Results: Serum hepcidin levels exhibited no significant differences
between patients with drug-­naïve RLS and healthy controls at a di-
agnosis (7.1 ± 2.4 vs. 7.0 ± 3.2 ng/ml, p = 0.357). Decreased hepci-
din levels were significantly associated with decreased RLS severity
(β = 0.002, 95% CI = 0.00−0.00, p = 0.005) and improved quality of
life (β = 0.002, 95% CI = 0.00−7.01, p = 0.044) in a dose-­dependent
manner after 12 weeks of treatment with a dopamine agonist. This
association was independent of age, sex, inflammatory markers,
sleep quality, insomnia, daytime sleepiness, depression, and anxiety.
Conclusions: This study demonstrates a role of hepcidin as a predic-
tor of therapeutic responses in RLS patients.
Disclosure: Nothing to disclose.
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P231 | Relationship between allergic rhinitis
and nasal surgery success in patients with
obstructive sleep apnea
K.-S. Cho; J.-H. Park; J.-H. Kang; S.-D. Kim
Otorhinolaryngology-­Head and Neck Surgery, Pusan National
University Hospital, Busan, Republic of Korea
Objectives/Introduction: The effectiveness of isolated nasal sur-
gery in treatment of obstructive sleep apnea (OSA) remains contro-
versial. The purpose of this study was to evaluate the subjective and
objective outcome after isolated nasal surgery in patients with OSA
and to determine the associated factors related to the success rate
of isolated nasal surgery.
Methods: The study population consisted of 35 patients with nasal
obstruction who had been diagnosed with OSA and were under-
going septoplasty and inferior turbinate reduction to correct nasal
pathologies. Preoperative drug-­induced sleep endoscopy was per-
formed to evaluate the obstruction site. Patients were assessed be-
fore and after nasal surgery using subjective outcomes measures,
including the Visual Analog Scale and Epworth Sleepiness Scale, as
well as by overnight polysomnography.
Results: All patients experienced improved nasal breathing post-
operatively. At 6 months postoperatively, patients exhibited sig-
nificant symptomatic improvement in snoring, sleep apnea, morning
headache, tiredness, and daytime sleepiness (p = 0.001, p = 0.016,
p = 0.001, and p = 0.005, respectively). Postoperative polysomnog-
raphy revealed significant improvement in the apnea-­
hypopnea
index (p < 0.001), respiratory disturbance index (p < 0.001), and per-
centage of time with oxygen saturation < 90% (p = 0.014). Although
the overall success rate of nasal surgery alone was 14.3%, the cri-
teria for success were met in 50% of patients with allergic rhinitis.
Furthermore, the success rate was significantly higher in patients
with moderate to severe nasal obstruction than in patients with mild
nasal obstruction (p = 0.033).
Conclusions: Among patients with OSA, those with allergic rhinitis
and severe nasal obstruction are likely to have a better surgical out-
come following isolated nasal surgery.
Disclosure: Nothing to disclose.
P232 | Comparative analysis of automatic
versus fixed positive airway pressure therapy for
severe obstructive sleep apnea
J.-H. Park; J.-H. Kang; S.-D. Kim; K.-S. Cho
Otorhinolaryngology-­Head and Neck Surgery, Pusan National
University Hospital, Busan, Republic of Korea
Objectives/Introduction: The purposes of this study were to com-
pare the purchase rate and adherence between CPAP and APAP, and
 |
184 of 356       ABSTRACTS
to determine the factors affecting the purchase rate and adherence
of PAP in the treatment of severe OSA.
Methods: From March 2016 to December 2017, 45 patients diag-
nosed with severe OSA by polysomnography were enrolled in this
study. Patients were prescribed CPAP or APAP by one doctor and
decided whether to purchase the machine after one month lease pe-
riod. Data from PAP were obtained following 4 months of prescrip-
tion. Adherence was defined as > 4 h/night on 70% of nights.
Results: The purchase rate of CPAP (84%) was significantly higher
than APAP (55%) (p = 0.033). However, there was no significant dif-
ference in adherence rate between CPAP (76%) and APAP (63%).
The mean pressure and 95th percentile leak were 8.62 cmH2O and
12.97 L/min in the CPAP and 10.55 cmH2O and 20.36 L/min in the
APAP. The mean pressure and 95th percentile leak were significantly
lower in the CPAP than APAP (p = 0.010 and p = 0.014, respectively).
Conclusions: Although the adherence was not significantly differ-
ent, the purchase rate was significantly higher in CPAP than APAP,
which might have been influenced by the pressure and leak accord-
ing to the PAP machine.
Disclosure: Nothing to disclose.
P233 | Mild sleep disturbances and sickness
predict sensitivity to frustration
L. Balter1; T. Sundelin1,2; J. Axelsson1,2
1 associated with poorer health outcomes.
Psychology Department, Stockholm University/Stress Research
2 Males tend to have higher prevalence of HRB when compared to
Institute; Karolinska Institutet, Stockholm, Sweden
Objectives/Introduction: Frustration is an affective response to a
perceived barrier, impairing cognitive functions such as attention,
judgement, and decision-­making. Even though sleep disturbances
and mild sickness are common, we know surprisingly little about
how these stressors affect one´s level of frustration or sensitivity to
becoming frustrated.
Methods: In this large online study, 518 participants (M age = 30.4,
SD  =  10.4) reported their sleep duration and quality, sleepiness,
and sickness symptoms. They then rated their general frustration,
and positive (i.e., optimism, focus, energy) and negative (i.e., de-
pression, sadness, anxiety, anger) emotions before and after a mild
frustration-­eliciting task. In the task, participants were instructed to
copy geometric shapes on a piece of paper, without lifting the pen
from the paper and without tracing over a line twice. Participants
were given three minutes to copy as many of the eight geometric
shapes as possible; however, in order to induce frustration, half of
the set of geometric shapes were unsolvable.
Results: Worse sleep quality, more sleepiness, sickness, but not
sleep duration, were associated with greater levels of frustration at
baseline (Bayes Factors [BFs10]) > 1000, ps < 0.001). Frustration sig-
nificantly increased from pre-­to post-­t ask, with larger increases in
those low and intermediate in sleep disturbances (except for sleep
duration) and sickness (BFs10 > 400, ps < 0.001) while those highest
in these stressors decreased (BFs10 > 400, ps  <  0.001) or did not
significantly change in frustration (BFs10 = 0-­1, ps > 0.05). Changes
in negative and positive emotions predicted frustration, suggesting
a potential pathway linking sleepiness, sleep quality, and sickness to
frustration.
Conclusions: These results suggest that normal variations in sleep
and sickness are associated with altered frustration as well as with
how sensitive someone is to become frustrated when engaged in a
mild frustrating environment.
Disclosure: Nothing to disclose.
P234 | Gender differences in Health Risk
Behaviors and its correlates during COVID-­19
pandemic
T. Paiva1,2,3; T. Gaspar3; R. Silva2; A. Feliciano1,2; J.
Pimentel1,2; J. Vaz Castro1,2; C. Reis1,3,4; H. Simião1,2; A.
Santa Clara1,2; R. Sousa2; C. Branquinho3; G. Tomé3; P.
Soares2; C. Nunes2; H. Canhão2; M. Gaspar de Matos3
1
CENC -­Sleep Medicine Center; 2CHRC -­Nova Medical School;
3
ISAMB -­Faculdade de Medicina, Universidade de Lisboa; 4IMM -­
Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
Objectives/Introduction: Health Risk Behaviors (HRB) are usually
women; the differences, however, tend to be less evident in western
societies.
The COVID-­
19 pandemic had unique characteristics, changing
people's habits, sleep and social interactions. During social crisis,
females are usually at higher risk of physical, economic and psycho-
logic distress.
To identify gender differences in HRB and health impacts regarding
the COVID-­19 pandemic in Portugal.
Methods: Via an online survey during the COVID-­19 period , we
evaluated gender differences in HRB, including sleep and their pos-
sible correlation with health comorbidities.
We obtained so far 605 answers addressed to the general popula-
tion with a detailed questionnaire of 130 questions using Survey
Legend platform.
Results: Gender differences in HRB concern: Total Sleep Time (prior
and during COVID) during week (p = 0.028; p = 0.049, respectively);
Number of awakenings during weekend (p = 0.001; p = 0.001, re-
spectively). Time using (prior and during COVID) Social networks
(p = 0.000; p = 0.015, respectively); mobile phones (p = 0.030;
p = 0.015, respectively), and virtual games (p = 0.000; p = 0.002, re-
spectively); present dependence on social networks (p = 0.021)and
alcoholic beverages (p = 0.000); Behaviors during lockdown: practic-
ing sports (p = 0.017); settling matters (p = 0.017); Food intake Fruits
(p = 0.047); processed food (p = 0.005); sweets (p = 0.037); more
meat and fish (p = 0.040); Smoking (p = 0.049). Behaviors prior to
ABSTRACTS
COVID no exercise (p = 0.046). All these behaviors were more fre-
quent in males, with exception of no exercise and fresh fruits.
Taking into account worsening or initiation of disorders with COVID
males had more sleep apnea (p = 0.000) and females more anxi-
ety (p = 0.047), gastrointestinal complaints (p = 0.049) and fatigue
(p = 0.017).
The associations between HRB and the number of morbidities (less
than 3; higher than 4 per subject), modulated by gender were com-
puted. Number of awakenings during the week and weekends, in-
gestion of fresh fruit/ vegetables, honey and marmalades, sweet
desserts, processed food, meat and fish, social networks, alcohol
and games dependence were significantly associated with comor-
bidities risk, mostly for low levels of morbid diseases.
Conclusions: HRB represent different risks for males and females.
Sleep features, food intake and daily habits have relevant associa-
tions with the intensity of morbid disorders
Disclosure: Nothing to disclose.
P235 | Prevalence and determinants of bad
sleep perception among Italian children and
adolescents
S. Malloggi1; F. Conte2; O. De Rosa2; G. Gronchi1; G. Ficca2;
F. Giganti1
1
NEUROFARBA, University of Florence, Florence; 2Psychology,
University of Campania -­Luigi Vanvitelli, Caserta, Italy
Objectives/Introduction: Despite the importance of sleep quality
for health in both children and adolescents, the proportion of good
and bad sleepers, as well as the determinants of sleep quality per-
ception, have not been systematically explored at these ages. Aim
of this study is to assess these two variables in Italian children and
adolescents.
Methods: A sample of 307 children (6–8 years, M = 164), 717
pre-­adolescents, (9–11 years, M = 373) and 406 adolescents, (12–
14 years, M = 194), completed the School Sleep Habits Survey
(Russo et al. 2007), which addresses Sleep quality perception (‘Do you
consider yourself a good or a bad sleeper?’); Sleep Habits (bedtime,
risetime; sleep duration; nap frequency); Sleep Measures (sleep la-
tency; awakening frequency); Sleep Problems; Circadian Preference;
Dreams (dreams´ frequency and quality). Subjective sleep quality
determinants were assessed through a stepwise logistic regression,
with Sleep quality perception as dependent variable and all other di-
mensions as independent variables.
Results: Being a bad sleeper was reported by 11.7% of the sample,
with a significant between-­groups difference (children: 8.3%; pre-­
adolescents: 11.3%; adolescents: 15.3%, chi2=8.62, p = 0.01). Sleep
2
quality was predicted: in children (pseudoR  = 0.397), by depressed
mood (p < 0.001), eveningness (p = 0.003) and unpleasant dreams
(p = 0.01); in pre-­adolescents (pseudoR 2 = 0.286), by sleep latency
(p = 0.009), awakening frequency (p = 0.001), depressed mood (<
|
      185 of 356
0.001) and unpleasant dreams (p < 0.001); in adolescents (pseu-
doR 2 = 0.288), by awakening frequency (p < 0.001), depressed mood
(< 0.001) and eveningness (p = 0.009).
Conclusions: Subjective perception of bad sleeping is rather frequent
across the whole sample, especially in adolescence, suggesting not
to neglect the issue of sleep quality in this age range. In children,
subjective bad sleep quality appears to be mainly determined by
psychological features related to daytime, e.g. depressed mood and
unpleasant dream recall, whereas, at later ages, sleep characteris-
tics, such as longer sleep latency and more frequent awakenings,
add to the former determinants. This could depend on: a) the ap-
pearance, with increasing age, of actual objective sleep modifica-
tions; b) a greater attention paid by adolescents to their own sleep
characteristics.
Disclosure: Nothing to disclose.
P236 | Three-­week observational study of
intervals between shifts and fatigue among
shift-­working nurses: comparison of 12-­hour and
16-­hour shift schedules in a 2-­shift system
T. Kubo1; S. Izawa1; H. Ikeda1; S. Matsumoto1; Y. Nishimura1;
M. Tamaki1; M. Takahashi1; T. Sasaki2; M. Okumura3; M.
Hashimoto3
1
National Institute of Occupational Safety and Health, Kawasaki; 2The
Ohara Memorial Institute for Science of Labour; 3Japanese Nursing
Association, Tokyo, Japan
Objectives/Introduction: This study was intended to examine how
shift combinations could be linked to sleep and fatigue among shift-­
working nurses who work 12-­hour (day/night: 12 h) or 16-­hour shifts
(day: 8 h/night:16 h) in a 2-­shift system.
Methods: Of 30 female participants, 15 nurses worked 12-­hour
shift schedules (mean and SD; 27.5 [2.1] yr.), and the others worked
16-­hour shift schedules (28.2 [3.4] yr.) Their working hours, sub-
jective fatigue, and actigraphic sleep were recorded for 3 weeks.
Their usual night-­shift napping was rated with a pre-­questionnaire.
Chronic stress was measured by hair cortisol before the study. These
measures were statistically compared among 5 different shift com-
binations in each of the 12-­and 16-­hour shifts (10 different shift
combinations in total).
Results: The distribution of intervals was shorter in the 12-­hour shift
schedule (median 23.5 hr. [min 8.5 -­ max 96.0]) than the 16-­ hour shift
schedule (33.5 hr. [11.0–103.0]). Regarding subjective fatigue, a one-­
way ANOVA showed a significant difference among 10 shift combi-
nations (p < 0.001). In particular, a higher level of subjective fatigue
was shown in the 2 consecutive day shift (DD; 8:00–20:30) and night
shift combinations (NN; 20:00 -­8:30) in the 12-­hour shift schedule.
Actigraphic sleep duration was approximately 1 hour shorter in NN
(5.2 ± 0.7 hr. ) than in DD (6.4 ± 0.6 hr.), while these combinations had
similar time intervals between shifts (NN; 11.0 hr., DD; 10.9 hr.). The
186 of 356       |
length of night-­shift napping was significantly longer in the 16-­hour
shift schedule (121.0 ± 9.4 min) than in the 12-­hour shift schedule
(63.3 ± 9.4 min). No significant difference between these schedules
was found in hair cortisol.
Conclusions: Nurse working 16-­hour shift schedules did not show
higher levels of subjective fatigue and objective stress compared
with their counterparts. A potential reason could be sufficient op-
portunities to nap during night shifts in a 16-­hour shift schedule. The
shift combinations with shorter intervals between shifts resulted in
shorter sleep duration, thereby increasing fatigue levels. Therefore,
a strategy for avoiding overtime is needed for these shift combina-
tions, especially for NN and DD in 12-­hour shift schedules.
Disclosure: This study was supported by the Industrial Disease
Clinical Research Grants from the Ministry of Health, Labour and
Welfare, Government of Japan (150903-­01).
P237 | The relationship between salivary and
urinary melatonin in young adults with myopia
(short-­sightedness) compared to normally sighted
young adults
G. Micic1; R. Chakraborty2; N. Lovato1; L. Thorley3; T.
Nissen3; L. Lack1
1 2
Adelaide Institute for Sleep Health; College of Nursing and Health
3
Sciences; College of Education, Psychology and Social Work, Flinders
University, Adelaide, SA, Australia
Objectives/Introduction: Myopia or short-­
sightedness is an in-
creasing epidemic that can predispose the eye to vision threatening
conditions. A recent, first-­of-­its-­kind study found a significant posi-
tive association between morning serum melatonin concentration
and the magnitude of myopia, with myopes demonstrating greater
serum melatonin concentration than emmetropes (normally sighted
individuals). The findings indicate the potential role of melatonin lev-
els in modulating myopia development. However, single timepoint,
cross-­sectional melatonin profile analyses were used that can only
represent the relapsing or descending phase of the melatonin curve
and not the differences in total melatonin production between my-
opes and emmetropes. This study aimed to comprehensively investi-
gate the melatonin serum concentration differences varied between
myopes and emmetropes.
Methods: Eighteen myopic (aged [mean  ±  standard devia-
tion] 22.9 ± 2.6 years) and 14 emmetropic young adults (aged
21.1 ± 1.6 years) completed online questionnaires and underwent a
comprehensive eye exam to confirm eligibility. Circadian timing was
assessed using salivary dim light melatonin onset, collected during
one overnight in a dimly lit sleep laboratory (< 10 lux). Participants
provided half-­hourly saliva samples for 7 hours, beginning 5 hours
before and finishing 2 hours after individual average sleep onset.
Total melatonin production was assessed via aMT6s levels from
ABSTRACTS
urine voids collected from 6 pm and until wake-­up time the follow-
ing morning, when the final void was made.
Results: Myopes (22:09 ± 1.8 hrs) exhibited a dim light me-
latonin onset phase-­delay of 1 hr 9 min compared to emmetropes
(21:00 ± 1.4 hrs), p = 0.03, d = 0.71. Urinary aMT6s melatonin levels
were significantly lower among myopes (29.17 ± 18.67) than emme-
tropes (42.51 ± 23.97, p = 0.04, d = 0.63).
Conclusions: Young adult myopes have significantly delayed circa-
dian rhythm timing than normal sighted emmetropes. Myopes also
have lower melatonin output, delayed and reduced sleep, and even-
ing diurnal preference compared to emmetropes. These findings in-
dicate a potentially important role of circadian rhythms in refractive
error development.
Disclosure: Nothing to disclose.
P238 | An evaluation of wind farm noise
effects on sleep using validated objective and
subjective sleep assessment: a systematic review
and meta-­analysis
T. Liebich1; P. Catcheside2; L. Lack 2; K. Hansen3; B.
Zajamsek2; N. Lovato2; G. Micic2
1
College of Education, Psychology and Social Work; 2College of
Medicine and Public Health; 3College of Science and Engineering,
Flinders University, Adelaide, SA, Australia
Objectives/Introduction: Little is known about the potential im-
pacts of wind farm noise (WFN) on sleep due to previous systematic
reviews targeting small scale cross-­sectional studies that primarily
focus on anecdotal impacts on sleep rather than psychometrically
validated, quantifiable self-­reported outcomes. Thus, the aim of the
present study was to more comprehensively review findings from
studies evaluating the potential impact of WFN using both objective
(i.e., polysomnography or actigraphy) and psychometrically validated
subjective sleep assessment tools.
Methods: Search terms included wind farm noise, wind turbine
noise, wind turbine sound, and sleep. Only original articles published
in English after 2000 were included. Studies reporting on sleep out-
comes in the presence of WFN that were not measured using objec-
tive or psychometrically validated subjective sleep assessment tools
were excluded. Uniform outcomes of the retrieved studies were
meta-­analysed to examine the effect of WFN on objective and sub-
jective sleep outcomes.
Results: Ten eligible studies were identified that assessed the impact
of WFN on objective sleep parameters, measured via actigraphy
or polysomnography; and/or subjective sleep estimates using the
Consensus Sleep Diary, Pittsburgh Sleep Quality Index, Insomnia
Severity Index or the Epworth Sleepiness Scale. Uniform outcomes
included objective sleep latency (SOL), total sleep time (TST), wake
after sleep onset (WASO) and sleep efficiency. Subjective sleep
estimates were not meta-­analysed due to measurement disparity.
ABSTRACTS
Meta-­analyses (n= number of studies included, Hedge's g [95% CI])
revealed no significant differences in objective SOL (n  =  5, 0.03
[−0.34 to 0.41]), WASO (n = 3, 1.86 [−7.54 to 11.27]), TST (n = 5, 0.05
[−0.77 to 0.67]), or sleep efficiency (n = 5, −0.25 [−0.71 to 0.22]) in
the presence versus absence of WFN (p's >0.05).
Conclusions: This meta-­analysis does not support that WFN sig-
nificantly impacts objective sleep measurements including SOL,
TST, WASO and sleep efficiency. Whilst, the included studies were
uniform in some of their outcome measures, the identified studies
varied largely in terms of their measurement, methodology, noise
intervention and participant samples. Thus, well-­controlled experi-
mental studies using ecologically valid WFN exposure, objective and
psychometrically validated subjective sleep assessment tools are
needed to provide more conclusive evidence regarding the impact
of WFN on sleep.
Disclosure: Nothing to disclose.
P239 | Suspected sleep disordered breathing
and work-­related sleep restriction in wildland
firefighters: impact on physiological stress
responses
A. Wolkow1; L. Main2; S. Ferguson3; B. Aisbett2; S. Windler3;
B. Edwards1,4; S. Jay3
1
Turner Institute for Brain and Mental Health, School of Psychological
Sciences, Monash University, Notting Hill; 2Institute of Physical
Activity and Nutrition, School of Exercise and Nutrition Sciences,
Deakin University, Burwood, VIC; 3Appleton Institute, Central
Queensland University, Adelaide, SA; 4Sleep and Circadian Medicine
Laboratory, Department of Physiology, Monash University, Notting Hill,
VIC, Australia
Objectives/Introduction: Sleep loss and certain sleep disorders,
such as sleep disordered breathing (SDB), are common among fire-
fighters and can contribute to potential dysregulation of inflamma-
tory and endocrine stress response systems. It is unknown, however,
whether SDB in wildland firefighters exposed to work-­related sleep
loss causes further dysregulation in these stress responses on the
fire-­ground. The current study examined stress responses in sleep
restricted wildland firefighters with suspected SDB compared to
those without SDB.
Methods: Firefighters completed 3 days of simulated firefighting
work separated by a 4-­h sleep opportunity on each of the 2 nights.
All sleep periods were recorded and based on oximetry desaturation
data, participants were retrospectively allocated to either an SDB
(n = 5) or non-­SDB control group (n = 9). Inflammatory cytokines (IL-­
6, IL-­8, IL-­1β, TNF-­α , IL-­4, IL-­10) and salivary cortisol were measured
each day at identical time-­points in both conditions.
Results: A fixed effect for condition showed higher overall levels of
IL-­6 in the SDB condition compared to participants in the non-­SDB
condition. Increases in cortisol and IL-­6 were also observed across
|
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each day of the simulation, but this was irrespective of whether fire-
fighters had SDB or not.
Conclusions: Findings highlight that firefighters with suspected SDB
have higher acute levels of IL-­6 during a multi-­day firefighting work
simulation separated by restricted sleep. Future research confirm-
ing, and longitudinally extending our findings in larger samples of
firefighters is needed to further understand how SDB and chronic
exposure to sleep loss on the fire-­ground affects firefighters’ inflam-
matory responses and their risk of associated health outcomes.
Disclosure: Nothing to disclose.
P240 | Prevalence of delayed sleep phase
syndrome (DSPS) among Omani people
M. Al-Abri1; T. Al-kindi1; I. Al-Lawati2
1
Sultan Qaboos University; 2Oman College of Health Science, Muscat,
Oman
Objectives/Introduction: Delayed sleep phase syndrome (DSPS) is
a circadian rhythm sleep disorder with a definition of delayed night
sleep by two or more hours beyond the socially acceptable or con-
ventional bedtime. The general reported prevalence of DSPS is 7%
to 16%. However, there is no previous study which assess DSPS
prevalence in Oman or nearby regions. This study aimed to assess
the prevalence of DSPS among Omani population and to establish a
connection between demographics and DSPS.
Methods: This community-­based study included 186 subjects aged
from 18 to 64 who had one week of actigraphy records along with
their demographical data in Sultan Qaboos University hospital.
Results: Among the 186, 19 (10.2%) subjects were identified of
having DSPS in weekdays, and 15 (11.4%) subjects have DSPS in
weekends. The results indicated that marital status had significant
relation (p = 0.02) more with unmarried group (62.50%, n = 10). No
significant relationship was found between DSPS and age, gender,
BMI, education and employment status in either weekdays or week-
ends (p > 0.05)
Conclusions: A consistent rates of DSPS were found among Omanis
which are 10.2% in weekdays and 11.4% in weekends. Also, DSPS
have significantly higher rates among unmarried subjects in week-
days. Further sophisticated studies in DSPS are needed to assess risk
factors and possible health impacts.
Disclosure: The study was funded by the research council of Oman
part of the data was presented in other sleep conferences
 |
188 of 356       ABSTRACTS
P241 | Effects of novel coronavirus pandemic
and self-­isolation on sleep disorders
S. Khachatryan1,2,3; M. Isayan1,4; H. Hovakimyan1,2; L.
Vardanyan1,2,3
1
Armenian Sleep Disorders Association; 2Sleep Disorders Center,
Somnus Neurology Clinic; 3Department of Neurology and
Neurosurgery, National Institute of Health; 4Yerevan State Medical
University, Yerevan, Armenia
Objectives/Introduction: COVID-­19 is a novel coronavirus disease
with severe respiratory illness in at-­risk population spread world-
wide since December 2019. Considering high spreading rates, many
countries applied restrictive measures, selecting self-­
isolation as
the main defence strategy. This massive home stay confinement led
to the disruption of daily life activities, work-­related stress, and in-
ability to maintain regular sleep-­wake regimen. Increased stress and
anxiety levels, depression, and violation of sleep hygiene, may evoke
new or worsen pre-­existing sleep disturbances. Our study aims to
evaluate sleep-­related disturbances (SD) during the quarantine and
comparison with the pattern preceding the declaration of a state of
emergency (SE) in Armenia in March-­May, 2020.
Methods: An online survey was developed by the research team and
distributed among social media users (age=>16). The survey con-
sisted of two blocks, referring to sleep-­related habits and complaints
before and during SE. We included points on insomnia, restless legs
syndrome (RLS) (four IRLSSG criteria applied), excessive daytime
sleepiness (EDS), snoring, waking due to shortness of breath (refer-
ring to sleep apnea, SA), unrefreshing sleep, and affective symptoms
-­depressive thoughts and anxiety before sleep. Chi-­square test was
used for statistical analysis.
Results: Overall, 635 participants mean age 30.7 years (16–66), fe-
males -­84.9% completed the survey. Insomnia and other SDs were
prevalent during the SE. We found significant differences in the
below-­mentioned variables during/before SE respectively (%): in-
somnia -­62.4/22.5, EDS -­42.8/67.8, RLS -­4.1/2.7, SA -­12.7/2.05,
snoring -­11.7/6.93, low mood -­79.4/20.8, anxiety -­71.5/22.7, un-
refreshing sleep -­46.3/86.2 (p < 0.001). Despite unequal sex dis-
tribution, otherwise, we had a large group of social media users
responding to our survey questions.
Conclusions: We found a high distribution of SDs among people dur-
ing SE. Furthermore, in comparison with prevalence of SDs prior to
the pandemic, we report a striking increase in all major categories
of SDs during SE, especially for insomnia, EDS, RLS, snoring, SA and
affective symptoms. We believe these results have further implica-
tions and are important also for the subjects’ mental and physical
health in the coming months.
Disclosure: Nothing to disclose.
P242 | A comparative study of the nature and
magnitude of problems sleeping in inflammatory
bowel disease (IBD) compared to healthy controls
A. Scott; O. Flowers; G. Rowse
University of Sheffield, Sheffield, United Kingdom
Objectives/Introduction: Inflammatory Bowel Disease (IBD) is
commonly associated with poor global sleep quality, and has been
posited as a modifiable determinant of IBD related outcomes, with
recent calls to screen for, and subsequently treat problems sleeping
as part of routine IBD care. However, there is little evidence on the
specific types of problems sleeping (e.g., sleep apnea, insomnia etc.)
that might characterize the poor sleep quality experienced by those
with IBD.
Methods: The present research aimed to investigate the severity
of seven specific types of problems sleeping in those with IBD vs.
a healthy control group. This cross-­sectional comparison study re-
cruited n = 409 with IBD, and n = 377 healthy controls (total sample
n = 786). The Sleep-­50 questionnaire was used to assess the pres-
ence of seven types of problems sleeping. Multivariate Analysis of
Covariance (MANCOVA) was used to compare the severity of sleep
disturbances between the IBD and control groups.
Results: Those in the IBD group reported significantly more severe
experiences of five of the seven domains of the Sleep-­50, includ-
ing increased; sleep apnea, insomnia, narcolepsy, restless legs, and
nightmares.
Conclusions: In conclusion, those with a diagnosis of IBD reported
significantly more severe symptoms across a range of specific prob-
lems sleeping when compared to controls. More research is needed
to; i) improve the identification and treatment of problems sleeping
in routine care; ii) understand the mechanism(s) of action that links
problems sleeping to IBD related outcomes; and iii) develop adapted
interventions to improve sleep in those with IBD.
Disclosure: Nothing to disclose.
P243 | Obstructive sleep apnea risk
assessment among hypertensive population in
primary care
J. Silva; M. Sampaio
USF Balsa, Tavira, Portugal
Objectives/Introduction: Obstructive sleep apnea (OSA) is highly
prevalent in the general population, and occurs at all ages. Despite
its prevalence, moderate/severe OSA could be undiagnosed in about
82% of men and 92% of women. OSA is characterized by collapse
of upper airways during sleep with ineffective respiratory efforts,
intermittent hypoxia and sleep disruption. OSA is very common
in patients with cardiovascular disease, especially in patients with
ABSTRACTS
hypertension. Over the last few decades, a number of discoveries
have helped support a causal relationship between the two and even
resistant hypertension. Furthermore, it is also the cardiovascular dis-
ease in which treatment with continuous positive airway pressure
(CPAP) has demonstrated efficacy in the most studies, so screening
for OSA in hypertensive patients should be systematically done.
This study aimed to evaluate the prevalence of high risk of undiag-
nosed OSA among patients with hypertension in primary care (PC)
setting who should be referred for diagnostic evaluation.
Methods: An observational, analytical and cross-­sectional study was
carried out on a sample of patients from a primary healthcare centre
which attended to a hypertension follow-­up medical appointment,
between April and September 2019. Sociodemographic and clinical
data were collected through a structured interview and from medi-
cal records. Risk of undiagnosed OSA was evaluated using the STOP-­
BANG questionnaire.
Results: 200 patients were the study object. The age was
68,81 ± 11,88 years, 52,50% were female patients, with a neck
circumference of 38.68 ± 5.14 cm and BMI of 28,97 ± 5,01 kg/m2.
Prevalence of high risk of OSA (STOP-­BANG score ≥ 3) was 79%.
Conclusions: There is a high prevalence of risk for undiagnosed OSA
in the sample analysed. OSA might be considered a modifiable risk
factor for adverse cardiovascular outcomes in these patients. PC has
a key role in early detection and facilitating diagnosis. The STOP-­
Bang questionnaire is an interesting triage tool for the primary
healthcare setting, selecting those with probable OSA for diagnos-
tic evaluation, predicting patients with a more severe disorder and
those who need faster treatment.
Disclosure: Nothing to disclose.
P244 | Sleep characteristics in patients with
interstitial lung disease
1 1 2 3
K.J. Myall ; A. West ; T. Simpson ; B. Kent
1 (FAW). Our study aimed to assess the prevalence of car accidents
Respiratory Medicine, Guy's and St Thomas’ NHS Foundation Trust;
2 (CA) in relation to the sleep disorders in Armenia.
University Hospital Lewisham, London, United Kingdom; 3St James’
Hospital, Dublin, Ireland
Objectives/Introduction: Both nocturnal hypoxaemia (NH) and ob-
structive sleep apnoea (OSA) are common in patients with interstitial
lung disease. We aimed to prospectively measure the incidence of
sleep disordered breathing in these patients, and assess the impact
on their daytime quality of life.
Methods: Prospective observational study of patients with an MDT
diagnosis of a fibrotic interstitial lung disease who all underwent a
home sleep study. Data was collected for demographic and clinical
characteristics, pulmonary function testing, six-­
minute walk test
(6MWT), and patient-­reported disease-­specific quality of life using
the King's Brief Interstitial Lung Disease questionnaire (KBILD)
Results: 43 patients were included. Eleven (23.3%) had nocturnal
hypoxaemia (defined by ≥ 10% of sleep with SpO2 ≤ 90%), and 15
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(34.9%) had at least moderate OSA (ODI ≥ 15). 4 patients (9.3%) had
NH in the absence of OSA.
Patients with OSA had a higher BMI than those without (31.61 ± 4.50
vs 27.54 ± 4.53, p = 0.01), but this was not the case for patients
with NH alone. These patients tended towards a lower BMI (BMI
24.4 ± 5.5 in patients with NH vs 30.0 ± 5.5, p = 0.26). Patients with
OSA had a lower FVC than those without 2.41L ±0.61 vs 2.77L ±
0.66 (p = 0.09). Conversely, patients with isolated NH tended to-
wards a higher FVC than those without (3.22L ± 0.69 vs 2.59 ± 0.24,
p = 0.09). There was no significant difference in gas transfer be-
tween the groups. Quality of life as measured by the disease-­specific
KBILD questionnaire was low in our cohort (mean 54.09 ± 20.75)
and was non-­significantly lower in patients with NH than those
without (52.57 ± 17.94) vs 55.43 ± 18.27, p = 0.67). In patients with
OSA, there was no difference in KBILD in those patients with OSA
when compared with those without (54.09 ± 20.75 vs 55.10 ± 16.65,
p = 0.86).
Conclusions: NH and OSA are common in patients with fibrotic in-
terstitial lung disease. As expected, patients with OSA were more
obese than those without and they also tended towards a lower
FVC. Patients with NH alone had a lower BMI and higher FVC than
those without. Patients with NH tended towards a lower patient-­
reported quality of life as measured by KBILD.
Disclosure: Nothing to disclose.
P245 | The prevalence of sleep-­related car
accidents in Armenia
M. Isayan; H. Hovakimyan; S. Khachatryan
Somnus Neurology Clinic, Yerevan, Armenia
Objectives/Introduction: Disrupted sleep is a common cause of
excessive daytime sleepiness (EDS) and falling asleep at the wheel
Methods: Armenian Sleep Disorders Association (ARSDA) con-
ducted a longitudinal study through a door-­to-­door interview. Our
study covered the adult population (=>18 years) from urban and
rural areas. The data are taken from results of an epidemiological
study regarding sleep disorders prevalence in Armenia performed
by ARSDA. The study questionnaire included 27 questions regarding
sleep disorders, and a point about experienced CA or a near-­miss.
Two groups were studied: CAG and nonCAG. Chi-­square analysis
was used.
Results: Among 1001 interviewed participants 21.4% were drivers
(n  =  214, females-­17.8%). The driving population was further di-
vided into those who reported a CA/near-­miss because of FAW -­
13.55% (CAG, n = 29, mean age 46), and those who did not (nonCAG,
n = 185, mean age 41.5). Mean sleep duration for general sample was
6.7 hours, while for CAG it was 6.56 hours, and 6.9 hours for nonCAG
(p > 0.05). Generally, insomnia was more prevalent in CAG (69.0%
 |
190 of 356       ABSTRACTS
against 39.5%, p < 0.05). Sleep-­onset insomnia was present in 37.9%
of CAG, whereas in nonCAG -­27.0% (p > 0.05). Sleep-­maintenance
insomnia was significantly more prevalent in CAG compared to non-
CAG (55.2% vs. 24.3%, p < 0.01). EDS was noted by 55.2% in CAG
and 41.1% in nonCAG (p > 0.05). Snoring was mentioned predomi-
nantly by CAG subjects: 62.1% vs. 36.8% (p < 0.01). Breathing stops
were more frequently noted by CAG -­41.4% vs. 19.5% (p < 0.01).
CAG participants complained of waking up in the morning with fa-
tigue more frequently (51.7%) than nonCAG (31.9%) (p < 0.05).
Conclusions: Our data show that sleep disorders are considered
an important risk factor for CA in drivers who experienced vehicle
crashes. There was a connection to shorter sleep duration, insomnia,
especially the sleep-­maintenance phenotype, and sleep-­disordered
breathing, such as snoring and sleep apnea. This is the first study
to focus on the problem of sleep at the wheel and related CAs in
Armenia.
Disclosure: Nothing to disclose.
P246 | Circadian phase tailored light therapy in
Alzheimer disease: preliminary findings on sleep
and cognition
R. Cremascoli1; D. Sparasci2; G. Giusti3; M. Picascia4; S.
Bernini4; V. Rustioni5; C. Ghezzi6; S. Cerri6; M. Terzaghi5; E.
Sinforiani4; R. Manni7
1
Department of Brain and Behavioural Sciences, Unit of Sleep Medicine
and Epilepsy, Department of Neurology and Neurorehabilitation,
University of Pavia| IRCCS Mondino Foundation | IRCCS Istituto
Auxologico Italiano, Porto Valtravaglia; 2Department of Brain and
Behavioural Sciences, Unit of Sleep Medicine and Epilepsy, Department
of Neurology and Neurorehabilitation; 3Department of Brain and
Behavioural Sciences, University of Pavia; 4Neuropsychology/
Alzheimer's Disease Assessment Unit, IRCCS Mondino Foundation;
5
Department of Brain and Behavioural Sciences/Unit of Sleep Medicine
and Epilepsy, University of Pavia/IRCCS Mondino Foundation;
6
Laboratory of Functional Neurochemistry; 7Unit of Sleep Medicine
and Epilepsy, IRCCS Mondino Foundation, Pavia, Italy
Objectives/Introduction: Our study aims to investigate the effects
of a tailored light therapy protocol on sleep and cognition param-
eters in patients with Alzheimer Disease (AD) of mild /moderate
severity.
Methods: Thirteen drug-­
free AD patients (M/F: 9/4; mean age
74 ± 5.4 years; mean MMSEc 20.7 ± 4.11) were consecutively inves-
tigated for cognitive and behavioral performances (MMSE, MoCA,
NPI, Beck), subjective nocturnal sleep parameters (MEQ, PSQI,
Epworth scale, SCADS, SCI), circadian phase (in-­home salivary Dim
Light Melatonin Onset, DLMO) and 7-­day/night actigraphy record-
ing before and after a single-­blind 4-­weeks tailored light therapy
(Luminette glasses with blue enriched light, equivalent dose of
10000 lux, 20 minute-­exposure at a daytime based on the DLMO)
versus sham protocol (Luminette/Sham group: 8/5 patients). P value
significance was set at p < 0.05.
Results: AD patients showed a mean DLMO clock time at baseline
of 21.18 ± 1.34 with a percentage of single DLMO clock time indica-
tive of late circadian phase in 46% of the cases. After light therapy
protocol 6 out 8 patients presented a circadian phase shift in ac-
cordance to the melatonin phase response curve, with a mean shift
time of 84.14 ± 49.4 minutes. Only 2 out 5 sham patients presented
a significant shift.
In Luminette group the mean 24-­hour total sleep time (TST) in-
creased after active light treatment with respect to pre treatment
condition showing a positive trend which was instead absent in the
Sham group (Luminette TST pre 512 ± 66 minutes, Luminette TST
post 584 ± 99.9 minutes, p = 0.27; Sham p = 0.43).
Subjective sleep quality improved nearly significantly in Luminette
group (pre 5 ± 2, post 3 ± 2, p = 0.05) but not in sham group (p = 0.44).
Despite a not significant difference between pre and post light
therapy MMSEc mean values (p = 0.07), however individual MMSEc
scores improved in 6 out of 8 AD patients with active light treat-
ment, while MMSE scores worsened in three out of five AD patients
on SHAM treatment.
Conclusions: In patients with mild/moderate forms of AD the light
therapy protocol tailored on the circadian phase proved to be as-
sociated to an objective phase shift in accordance to the melatonin
phase response curve, a trend to an increased subjective sleep qual-
ity, 24-­hour TST and cognitive performance.
Disclosure: Nothing to disclose.
P247 | Ambient temperature (Ta) manipulation
as a novel technique to dissociate REM sleep and
cataplexy in narcolepsy
B. Viberti; L. Branca; C.L.A. Bassetti; A. Adamantidis; M.H.
Schmidt
Inselspital, Bern University Hospital, Bern, Switzerland
Objectives/Introduction: The lateral hypothalamic melanin-­
concentrating hormone (MCH) system is critical for increasing
REM sleep during thermoneutral ambient temperature warming
(Komagata et al. Curr. Biol., 2019). Given the role of the hypocre-
tin system in MCH inhibition, we hypothesized that hypocretin loss
in narcolepsy may enhance REM expression or cataplexy during Ta
warming. We then investigated the occurrence of cataplexy, both as
spontaneous events and during a food-­elicited cataplexy test, and
REM sleep as a function of ambient temperature in narcoleptic hypo-
cretin Knock-­out (Hcrt-­KO) mice during the dark phase.
Methods: Mice (n = 11) were implanted for sleep-­wake monitoring
with additional video recording for cataplexy and actigraphy analy-
ses. Thermoneutral Ta warming bouts were presented during the
dark phase as previously described (Komagata et al. Curr. Biol., 2019).
Hcrt-­KO mice (n = 9) also underwent a food elicited cataplexy test
ABSTRACTS
(FECT) using milk chocolate as a highly palatable food and placed in
the recording cage prior to lights out.
Results: The FECT revealed a dynamic dissociation of REM sleep ex-
pression and cataplexy as a function of Ta. Specifically, during the
warming phases we observed an increase in REM sleep and a signifi-
cant decrease in cataplexy, whereas an opposite dynamic modula-
tion occurred during the cooling phase. This effect of Ta on REM
sleep and spontaneous cataplexy was also observed in the absence
of chocolate, showing that Ta warming significantly reduced sponta-
neous cataplexy while increasing REM sleep expression. Repeated
measures one-­way ANOVA has been used and a Tukey's adjust-
ment was applied to ensure correction for multiple comparisons.
Sleep-­wake recording data and video actigraphy analyses showed
no significant differences in either wake durations or activity levels
between the warm and cool phases, suggesting that the effects on
REM sleep and cataplexy are independent of wake or activity levels.
Conclusions: Taken together, these results suggest that in narco-
lepsy, Ta manipulation may present a novel technique to dissect
neural mechanisms underlying REM sleep and cataplexy while pre-
senting a potential human application to modulate their expression
for clinical or research aims.
Disclosure: Nothing to disclose.
P248 | The role of sleep problems in the
cognitive behavioural model of compulsive
checking behaviours
M.L. Wong1; C.N.W. Leung2; K.N.T. Lau3; E.Y.Y. Lau4,5
1
Psychology, University of Exeter, Exeter, United Kingdom; 2Psychology,
Chinese University of Hong Kong; 3Clinical Psychological Services,
Hong Kong Children & Youth Services; 4Psychology, Education
University of Hong Kong; 5Psychiatry, University of Hong Kong, Hong
Kong, Hong Kong
Objectives/Introduction: Sleep problems have been found to pre-
dict anxiety and memory functioning, which are the core cognitive-­
behavioural factors perpetuating the Obsessive-­compulsive disorder
(OCD) symptoms in compulsive checkers. This study aims to model
the relationship among sleep, memory complaint, anxiety and com-
pulsive checking symptoms, given that doubting and checking be-
haviours were the most common themes in OCD.
Methods: Participants (n = 191), mean age = 20.5, 63.2% female, com-
pleted self-­reported measures on OCD checking symptoms, anxiety,
memory complaint and sleep condition. They also completed a sleep
diary and wore an actigraph-­watch for 7 days. Sleep debt was com-
puted by subtracting total sleep time from self-­reported sleep need.
On day 6, participants completed an objective memory assessment,
the Modified Rey-­Osterrieth Complex Figure Test in our labora-
tory. 43.8% of the sample had significant OCD symptoms measured
by the Obsessive-­
compulsive inventory-­
revised, and 44.3% with
at least mild level of anxiety symptoms measured by Depression
|
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Anxiety Stress Scale. 59% were classified as poor sleeper by the
Pittsburgh Sleep Quality Index.
Results: Correlation analyses with adjustment for multiple com-
parisons showed that checking symptoms were correlated with
both subjective sleep quantity, e.g. sleep debt measured by sleep
diary, r = 0.22, p = 0.004, and subjective quality measures, e.g.
PSQI-­measured sleep disturbance, r = 0.20, p-­0.007, but not with
objective sleep measures or sleep timing and variability measures,
ps > 0.05. Subjective memory complaint, but not objective memory
measures, ps > 0.05, was also correlated with sleep debt, r = 0.24,
p = 0.002, and sleep disturbance, r = 0.22, p = 0.003.
Results from structural equation modelling showed a very good fit
index: comparative fix index = 0.99, root mean square of error ap-
proximation = 0.032, p = 0.516, standard root mean residual = 0.041,
for the model with sleep debt and sleep disturbance as predictors,
subjective memory complaint and anxiety symptoms as mediators
and checking symptoms as outcome variables. There was a significant
indirect effect of sleep debt, estimate = 0.021, bias-­corrected 95%
confidence interval (BCCI) = 0.003–0.058, and sleep disturbance, es-
timate = 0.014, BCCI = 0.003–0.038, on checking symptoms through
memory complaint and subsequently anxiety symptoms
Conclusions: Our results indicate sleep shoulders a role in relating
to compulsive checking symptoms through memory complaint and
anxiety, suggesting that existing OCD treatment may consider tar-
geting sleep problems, which are highly treatable, to further aug-
ment the treatment effectiveness.
Disclosure: This study is funded by the General Research Fund
(EdUHK#18619616), of the Research Grant Council, Hong Kong.
P249 | Quality of life in a phase 3, placebo-­
controlled, double-­blind, randomised withdrawal
study of JZP-­258 in adults with narcolepsy with
cataplexy
K. Šonka1; M.J. Thorpy2; Y. Dauvilliers3,4; A. Roy5; L. Tang6;
R. Skowronski7; N. Foldvary-Schaefer8; R.K. Bogan9
1
First Faculty of Medicine, Charles University and General University
Hospital, Prague, Czech Republic; 2Albert Einstein College of Medicine,
Bronx, NY, United States; 3Sleep and Wake Disorders Centre,
Department of Neurology, Gui de Chauliac Hospital; 4University of
Montpellier, INSERM U1061, Montpellier, France; 5Ohio Sleep Medicine
Institute, Dublin, OH; 6Formerly Jazz Pharmaceuticals, Inc; 7Jazz
Pharmaceuticals, Inc., Palo Alto, CA; 8Cleveland Clinic Lerner College
of Medicine, Cleveland, OH; 9University of South Carolina School of
Medicine, Columbia, SC, United States
Objectives/Introduction: Narcolepsy negatively impacts health-­
related quality of life (HRQoL). Sodium oxybate is a standard of care
for the treatment of cataplexy and excessive daytime sleepiness
in narcolepsy. JZP-­258 is an oxybate product candidate with 92%
less sodium. Efficacy and safety of JZP-­258 were established in a
 |
192 of 356       ABSTRACTS
double-­blind randomised withdrawal study in adults with narcolepsy
with cataplexy. HRQoL endpoints from this study are presented.
Methods: Participants 18–70 years of age began JZP-­258 treatment
during a 12-­week, open-­label, optimised treatment and titration pe-
riod, followed by a 2-­week stable-­dose period (SDP). Participants
were then randomised to receive placebo or continue JZP-­258 treat-
ment during a 2-­week, double-­blind, randomised withdrawal period
(DBRWP). HRQoL assessments included the 36-­Item Short Form
Health Survey Version 2 (SF-­36) and 5-­level EuroQoL 5-­Dimensions
Self-­Report Questionnaire (EQ-­5D-­5L).
Results: 201 participants enrolled; 134 were randomised and re-
ceived at least 1 dose of double-­blind study medication (efficacy
population; placebo, n  =  65; JZP-­258, n  =  69). Decreased scores
(worsening) were observed in participants randomised to placebo
compared with participants randomised to continue JZP-­258 treat-
ment for the SF-­36 physical component summary (median [Q1,
Q3], −1.92 [−3.46, 1.73] for placebo and −0.03 [−2.07, 2.41] for JZP-­
258; nominal p =  0.02), SF-­36 mental component summary (−1.92
[−6.28, 1.34] for placebo and 1.55 [−1.88, 3.78] for JZP-­258; nominal
p = 0.03), and EQ-­5D-­5L visual analog scale (−5.00 [−10.0, 5.00] for
placebo and 0 [0, 5.00] for JZP-­258; nominal p = 0.01). No change
was observed in the EQ-­5D-­5L crosswalk index (0 [−0.05, 0.03] for
placebo and 0 [−0.01, 0.03] for JZP-­258; nominal p = 0.39). The over-
all safety profile of JZP-­258 was similar to sodium oxybate.
Conclusions: HRQoL worsened in those randomised to placebo dur-
ing the 2-­week DBRWP but remained stable in participants who
continued JZP-­258 treatment.
Disclosure: Support: Jazz Pharmaceuticals. K Šonka has served
on the speakers’ bureau for Sanofi, Angelini, and Stada and par-
ticipated in advisory boards for UCB and in clinical trials for Jazz
Pharmaceuticals, Flamel-­
Avadel, and Luitpold Pharmaceuticals.
MJ Thorpy has received research/grant support and consultancy
fees from Jazz Pharmaceuticals, Harmony Biosciences, Balance
Therapeutics, Axsome Therapeutics, and Avadel Pharmaceuticals.
Y Dauvilliers is a consultant for and has participated in advisory
boards for Jazz Pharmaceuticals, UCB Pharma, Flamel Technologies,
Theranexus, and Bioprojet. A Roy has received consultancy fees
from Jazz Pharmaceuticals and Harmony Biosciences. L Tang is
a former consultant with Jazz Pharmaceuticals. R Skowronski is a
full-­time employee of Jazz Pharmaceuticals who, in the course of
this employment, has received stock options exercisable for, and
other stock awards of, ordinary shares of Jazz Pharmaceuticals,
plc. N Foldvary-­Schaefer has served on an advisory committee for
Jazz Pharmaceuticals and participated in clinical trials supported by
Jazz Pharmaceuticals, Suven, and Takeda. RK Bogan has served on
the speakers’ bureau and participated in advisory boards for Jazz
Pharmaceuticals.
P250 | Neuronal surface antibodies are
common in children with narcolepsy and active
movement disorders
M.P. Giannoccaro1,2; F. Pizza3,4; L. Jacobson2; R. Liguori3,4; G.
Plazzi3,4; A. Vincent2
1
Department of Biomedical and Neuromotor Sciences, IRCCS Istituto
delle Scienze Neurologiche di Bologna, Bologna, Italy; 2Nuffield
Department of Clinical Neurosciences, University of Oxford, Oxford,
United Kingdom; 3IRCCS Istituto delle Scienze Neurologiche di Bologna;
4
Department of Biomedical and Neuromotor Sciences, University of
Bologna, Bologna, Italy
Objectives/Introduction: To study a large cohort of patients, adults
and children, with narcolepsy type 1 (NT1) for the presence of active
movement disorders and investigate their association with antibod-
ies against neuronal surface antigens (NSAbs) such as NMDAR, LGI1,
CASPR2, that can be associated with movement disorders.
Methods: Fifty-­eight patients (36 adults, 22 children), with NT1 (doc-
umented cataplexy and low cerebrospinal fluid hypocretin-­1) were
studied. Active and negative motor phenomena were video recorded
at diagnostic evaluation, and active and negative motor scores were
compiled for each patient, as previously reported. NSAbs were iden-
tified in serum by live cell-­based antigen specific assays.
Results: ‘Active’ motor phenomena were found in 25/58 NT1 pa-
tients (43%) and were more frequent in children (14/22; 64%) than
adults (11/36; 31%; p = 0.017), with higher active movement scores
in children (p = 0.002). Overall, 8/58 (14%) patients had specific
NSAbs. Four had antibodies to NMDAR, three to HCRTR2 and one
to LGI1. At the time of study, six were children and two were adults.
All eight patients with NSAbs had active movement disorders, com-
pared with only 17/50 without such antibodies (p = 0.001).
Conclusions: Active movement disorders are found in adults as well
as children with NT1, but more frequent and complex in the children.
NSAbs (to NMDAR, HCRTR2, LGI1) were
common in NT1, and strongly associated with active movements.
Further studies on recent onset cases, documenting specific anti-
bodies and ‘active’ movements could prompt consideration of im-
munomodulatory treatment in individual cases.
Disclosure: Nothing to disclose.
ABSTRACTS
P251 | Interim cohort description of SOMNIA,
a dataset containing clinical polysomnography
combined with novel unobtrusive sleep
monitoring techniques
F.B. van Meulen1,2; J.P. van Dijk1,2; R. Krijn1,2; B. Hoondert2;
P. Fonseca1,3; S. Pillen1,2; S. Overeem1,2; M.M. van Gilst1,2
1
Electrical Engineering | Signal Processing Systems, Eindhoven Technical
University, Eindhoven; 2Centre for Sleep Medicine, Kempenhaeghe
Foundation, Heeze; 3Philips Research, Eindhoven, The Netherlands
Objectives/Introduction: Research on advanced data analysis tech-
niques and unobtrusive measurement modalities are gaining increas-
ing interest in the area of sleep monitoring. The objective of the
SOMNIA study is to create a large-­scale dataset for the validation
of new sleep monitoring techniques against gold standard polysom-
nography (PSG) in a representative group of sleep clinic patients.
Furthermore, the dataset can be used for development and valida-
tion of new data analysis techniques.
Methods: Subjects are recruited among patients who are planned
for PSG as part of the standard diagnostic process at sleep medicine
centre Kempenhaeghe, Heeze, The Netherlands, a third-­line referral
centre. All PSGs are recorded according AASM standards and an-
notated by expert sleep technicians. In addition, newly developed
and unobtrusive sleep monitoring sensing modalities are recorded
simultaneously, including wrist-­worn reflective photoplethysmog-
raphy, pressure sensing mattresses, multimicrophone recording of
respiratory sounds, suprasternal pressure monitoring and multi-
electrode electromyography of the diaphragm. We aim to include
2100 subjects with a variety of age, and sleep disorders. Details on
the measurement protocol are published (van Gilst et al. https://doi.
org/10.1136/bmjop​en-2019-030996).
Results: Currently, data of 943 subjects are included in the data-
set with a full PSG recording. Adults: 839 (50.79 ± 14.94 years), 528
males and 311 females. Children: 104 (10.6 ± 4.8 years), 65 males
and 39 females. The number of recordings with additional sensors
are: photoplethysmography: 835; pressure sensing mattress: 365;
Multimicrophone: 237; Suprasternal pressure: 120; Diaphragm elec-
tromyography: 60. The number of sleep diagnoses are summarised
according the international classification of sleep disorders (subjects
could be diagnosed with multiple disorders): Insomnia: 335; Sleep
related breathing disorders: 528 (of which obstructive sleep apnoea
adult: 480, paediatric: 25); Central disorders of hypersomnolence:
45; Circadian rhythm sleep-­wake disorders: 28; Parasomnias: 154;
Sleep related movement disorders: 172. Other behavioural related
sleep disorders (behaviourally induced insufficient sleep syndrome
and inadequate sleep hygiene): 83.
Conclusions: The SOMNIA dataset is a unique dataset containing
simultaneously recorded clinical PSG data and sensor data of dif-
ferent novel sensor modalities. It includes a representative group of
sleep clinic patients with a broad range of sleep disorders of varying
|
      193 of 356
age. When completed, the SOMNIA set will be a valuable source for
sleep medicine research.
Disclosure: At the time of writing, PF was employed by Royal Philips,
a commercial company and manufacturer of consumer and medical
electronic devices, commercializing products in the area of sleep
diagnostics and sleep therapy. Their employer had no influence on
the study and on the decision to publish. The other authors declare
that they have no competing interests. Financial disclosure: The
SOMNIA study was supported by an Impulse grant (Advanced Sleep
Monitoring, 2016), and Open Technology Program (OSA+, STW/
NWO, project no. 14619). These funding sources had no role in ei-
ther study design or writing the abstract.
P252 | Validation and optimization of
automatized sleep spindle detectors in elderly
healthy subjects and patients with Parkinson's
disease
L. Rose1; H. Leonthin2; M. Nikolic2; P. Jennum2; J.A.E.
Christensen1,2
1
Department of Health Technology, Technical University of Denmark,
Lyngby; 2Department of Clinical Neurophysiology, Rigshospitalet,
Danish Center for Sleep Medicine, Glostrup, Denmark
Objectives/Introduction: Implementation of an Automatic Sleep
Spindle Detector (ASSD) could help standardize scorings of sleep
spindles (SS). In this study three ASSDs were implemented to in-
vestigate their performance in detecting SS in respectively healthy
subjects and Parkinson's Disease (PD) patients, before and after
optimization. The implemented ASSDs were inspired from Latreille
et al. (ASSD-­L;[1]), Schimicek et al. (ASSD-­S;[2]) and Ferrarelli et al.
(ASSD-­F;[3]).
Methods: Polysomnographic electroencephalography data from 15
PD patients and 15 healthy elderly were included. SS were manu-
ally identified in 20 minutes of noise-­free N2 sleep by five experts,
and a gold standard was defined by a group consensus (GS) [4]. The
optimization was based on parameter studies including the param-
eters: amplitude-­threshold, root-­mean-­square (rms)-­EMG and rms-­
ratio between alpha and SS (ASSD-­S), lower and upper threshold
(ASSD-­F ) and percentile (ASSD-­L). A leave-­one-­subject-­out training
approach was applied for 12/15 controls. The performances of the
optimized ASSDs were evaluated on a test set of 3/15 controls and
15 patients based on a by-­event F1-­score, where detected events
were considered true positives if they overlapped with a SS from GS
with more than 20%.
Results: The optimal parameters were estimated to 13, 2 and 1.9
(ASSD-­S); 3·[most-­common-­envelope-­peak-­amplitude] and 6·mean
S); and 96.2th-­percentile (ASSD-­L). The F1-­score
(|signal|) (ASSD-­
(µ±σ) for the test controls changed from 0.20 ± 0.14 to 0.41 ± 0.10
(ASSD-­F ), 0.49 ± 0.15 to 0.59 ± 0.02 (ASSD-­S), and 0.36 ± 0.09 to
0.35 ± 0.12 (ASSD-­L). Furthermore, the F1-­score for the PD patients
 |
194 of 356       ABSTRACTS
changed from 0.20 ± 0.20 to 0.29 ± 0.30 (ASSD-­F ), 0.30 ± 0.30
to 0.35 ± 0.32 (ASSD-­S), and 0.28 ± 0.30 to 0.27 ± 0.28 (ASSD-­L).
All ASSDs detected SS in the control group, however, none of the
few SS from GS were detected in 2/15 PD patients (ASSD-­F and
ASSD-­S) and 3/15 PD patients (ASSD-­L). The inter-­group compari-
son (Wilcoxon tests) showed that none of the ASSDs performed
significantly different (p = 0.94 (ASSD-­F ), p = 0.94 (ASSD-­S) and
p = 0.48 (ASSD-­L)) between groups.
Conclusions: The parameter studies improved the ASSDs for both
groups. Although the mean F1-­scores were consistently lower for
the PD group compared to the test controls, it did not differ signifi-
cantly between groups. Yet, a dataset with more subjects and scor-
ings outside N2 sleep is required to fully investigate the robustness
of the ASSDs.
Disclosure: [1] Latreille et al. ‘Sleep spindles in Parkinson´s disease
may predict the development of dementia’. Neurobiology of Aging
— 2015, Volume 36, Issue 2 [2] Schimicek et. al. ‘Automatic Sleep-­
Spindle Detection Procedure: Aspects of Reliability and Validity’.,
Clinical EEG and Neuroscience 1994, vol. 25, issue 1 [3] Ferarelli, F
et al. ‘Reduced sleep spindle activity in schizophrenia patients’. Am J
Psychiatry 164:3. March 2007. [4] Christensen, Julie A E et al. “Sleep
spindle alterations in patients with Parkinson's disease.” Frontiers in
Human Neuroscience vol. 9 233. May 2015.
P253 | 20 years of hypocretin-­1 measurements
in cerebrospinal fluid using radioimmunoassay:
technical and clinical lessons
1,2 1 1,2
A. van derHoeven ; K. van Waaij ; M. Schinkelshoek ; F.
Roelandse3; J. Bakker3; R. Fronczek1,2; G.J. Lammers1,2
1 2
Neurology, Leiden University Medical Center, Leiden; Sleep-­Wake
Centre, SEIN, Heemstede; 3Department of Clinical Chemistry and
Laboratory Medicine, Leiden University Medical Center, Leiden, The
Netherlands
Objectives/Introduction: The measurement of the hypocretin-­
1 sleep patterns at night might affect the sleep architecture during a
concentration in cerebrospinal fluid (CSF) with a radioimmunoassay
(RIA) is the most sensitive and specific laboratory method in the di-
agnosis of narcolepsy type 1 (NT1). Despite being considered the
preferred method, the extent of the variability within and between
RIAs has not been systematically evaluated. Neither is a reliable limit
of quantitation (LOQ) established. There also are hardly publica-
tions verifying the currently globally accepted diagnostic criterion
of a CSF concentration < 110 pg/ml (Stanford adjusted value). In this
study we describe the 20-­year experience with the technical aspects
of RIA measurement and the correlation of the hypocretin-­1 value
with diagnostic criteria.
Methods: We retrospectively analyzed a dataset containing raw
data of 74 consecutive RIAs. We calculated the inter-­assay coeffi-
cient of variation (inter-­assay CV, expressing the extent of variation
between assays), as well as the intra-­assay coefficient of variation
(intra-­assay CV, expressing the variation within an assay) per RIA and
LOQ (defined as the lowest concentration correlated to the Stanford
reference with a CV < 15%).
In addition to the above we aim to evaluate clinical findings in rela-
tion to the low, intermediate and normal hypocretin-­1 concentration
ranges in a subgroup of clinically well described patients (n = 328).
These results will be added at a later date.
Results: The mean intra-­assay CV was 4.6% (SD ± 2.9%), while the
inter-­assay CV uncorrected to Stanford was 28.6% (18.1% without
4 outliers) and 7.2% (with and without the outliers) when corrected.
The LOQ was established at 58.5 pg/ml. The intra-­assay CV of RIAs
with lower specific activity showed a median of 4.7% (min 1.6%,
max 17.0%, n = 36) as compared to a median of 3.3% (min 0.4%, max
11.6%, n = 35) of RIAs with higher specific activity, a significant dif-
ference (p = 0.033).
Conclusions: These findings underline the importance of harmoniza-
tion using reference materials and establish that the specific activity
of a RIA (because of the decay of I125 radioactivity) has a significant
impact on its reliability. Lastly, based on these results we consider
concentrations below 60 pg/ml as undetectable.
Disclosure: Nothing to disclose.
P254 | Effects of night-­time sleep quantity,
quality and timing on the architecture of a
daytime nap
E.Y.Y. Lau1; M.L. Wong2; K.N.T. Lau3; Y.C. Lam1
1
Psychology, Education University of Hong Kong, Hong Kong, Hong
Kong; 2Psychology, University of Exeter, Exeter, United Kingdom;
3
Clinical Psychological Services, Hong Kong Children & Youth Services,
Hong Kong, Hong Kong
Objectives/Introduction: Experimental daytime napping protocol is
commonly used in sleep research with participants’ sleep patterns
prior to the nap well controlled, leaving limited knowledge on how
daytime nap. The aim of this study was to explore how habitual sleep
patterns might affect the sleep architecture of a daytime nap.
Methods: 141 college students (mean age = 20.1, 37.6% male, aver-
age sleep duration: 7.2 h) completed the Pittsburgh Sleep Quality
Index (PSQI) and wore an actigraph-­watch for 7 days. They came to
the laboratory for a polysomnography-­monitored nap at 1300–1430
on Day 6 and returned the actigraph-­watch with sleep diary on Day
7 after sleeping at home on Day 6 night. Correlational analyses with
multiple comparisons adjusted following Benjamini-­Hochberg pro-
cedure were used to study the relationship between nighttime sleep
patterns and sleep architecture during the daytime nap.
Results: Poorer sleep quality PSQI total score was associated with
longer sleep duration, r = 0.182, p = 0.031, and higher sleep effi-
ciency, r = 0.190, p = 0.025, and shorter latency in entering rapid-­
eye-­
movement sleep stage (REM latency) during nap, r = 0.217,
ABSTRACTS
p = 0.033. Longer 6-­day average of sleep duration was associated
with lower sleep efficiency during nap, r  =  −0.193, p = 0.03. Later
mid-­sleep time (midpoint of bedtime to waketime) was associated
with shorter REM latency, r = −0.238, p = 0.023, longer REM dura-
tion, r = 0.305, p < 0.001, and longer duration of Stage 1 sleep during
nap, r = 0.234, p = 0.008. A more variable sleep-­wake timing, meas-
ured by the standard deviation of mid-­sleep time, was correlated
with longer sleep duration, r = 0.269, p = 0.002, higher sleep effi-
ciency, r = 0.306, p = 0.001, shorter sleep onset latency, r = −0.251,
p = 0.005, and shorter wake after sleep onset during nap, r = −0.193,
p = 0.031. In addition, the napping polysomnographic measures did
not significantly correlate with the actigraphic sleep variables in the
following night.
Conclusions: Our findings suggest that the experience and the po-
tentially the subsequent effects of a daytime nap might be moder-
ated by one's habitual sleep characteristics. The differential effects
of daytime napping in neuropsychological outcomes in individuals
with diverse habitual sleep patterns are to be further investigated
and should be taken into account in studies adopting the napping
paradigm
Disclosure: This study is funded by the General Research Fund
(EdUHK#18619616), Research Grant Council, Hong Kong.
P255 | A cross-­sectional study of self-­
reported sleep duration and cardiometabolic
disease characteristics in corporate employees:
correlates and mediators
P.R. Pienaar1; D.E. Rae1; L.C. Roden2; C.R.L. Boot3; W. van
Mechelen4; J.W.R. Twisk5; E.V. Lambert1
1
University of Cape Town, Cape Town, South Africa; 2Coventry
University, Coventry, United Kingdom; 3Radboud University, Nijmegen;
4
Vrije Universiteit, Amsterdam; 5University of Groningen, Groningen,
The Netherlands
Objectives/Introduction: Short sleep duration is associated with
cardiometabolic disease (CMD) in the general population. In employ-
ees at top-­level management, whose working practices are typified
by longer work hours and time pressures, the relationship between
sleep duration and CMD risk factors remain unclear and evidence of
sex differences are scarce. We therefore aim to describe the asso-
ciations between self-­reported sleep duration and CMD risk factors,
correlates of sleep duration and the effect of potential mediators of
this relationship in corporate employees.
Methods: Self-­reported sleep duration, lifestyle -­, occupational -­,
and psychological factors were obtained from the health risk as-
sessment data of 3583 office-­
based administrative, professional
and executive employees (2543 men and 1042 women). A con-
tinuous CMD risk score was calculated using fasting serum HDL,
plasma glucose, serum triglycerides, body mass index (BMI), waist
circumference, systolic and diastolic blood pressure. Sex-­stratified
|
      195 of 356
regression analyses investigated the relationships between sleep du-
ration, CMD risk factors, occupational and psychological variables.
Mediation analyses described the magnitude and effect of potential
mediators on the relationship between self-­reported sleep duration
and CMD risk factors.
Results: After adjusting for covariates, sleep duration was inversely
associated with BMI (p < 0.05), waist circumference (p < 0.05) and
CMD risk score (p < 0.05) overall, and inversely with diastolic blood
pressure (p < 0.05) in men, and positively associated with HDL cho-
lesterol in women (p < 0.05). Long work hours, daily travel time,
depression, anxiety and stress were correlates for shorter sleep du-
ration in men and women. Physical activity, working hours and stress
mediated the association between self-­reported sleep duration and
BMI, waist circumference, diastolic blood pressure and CMD risk
score in men only.
Conclusions: Self-­reported sleep duration is associated with CMD
risk factors in corporate employees. While long working hours and
stress are correlates of shorter sleep in both sexes, only in men, was
the relationship between sleep duration and CMD risk factors me-
diated by work hours, physical activity and stress. These findings
motivate for the inclusion of sleep improvement interventions in
workplace health programmes.
Disclosure: Nothing to disclose.
P256 | Does sleep deprivation cause stress in
mice? A comparison of gentle handling versus
novel object presentation sleep deprivation
methods
L. Lignos; M. Nollet; W. Wisden; N.P. Franks
Imperial College London, London, United Kingdom
Objectives/Introduction: Sleep deprivation is widely used to study
the functions of sleep in laboratory animals. Gentle handling (GH)
and novel object presentation (NO) are two well-­established meth-
ods of sleep deprivation. However, it is unclear whether these sleep
deprivation methods cause long-­lasting stress in mice and whether
one method is more stressful compared to the other. The objective
of this study was to compare the stress level of mice subjected to
sleep deprivation using the GH or NO protocols.
Methods: Single-­housed mice were sleep deprived in their home
cage for 6 hours by either presenting novel objects at timed inter-
vals (NO), by tapping their cage and gently handling when showing
signs of sleep (GH) or were kept undisturbed (non-­sleep-­deprived
control group) in a crossover study (n = 6 mice per group; 12-­hour
light/dark cycle). The level of stress was assessed non-­invasively
by quantifying faecal corticosterone metabolites (FCM) at several
time points throughout the 24-­hour period using ELISA. The 6-­hour
sleep deprivation was performed at the beginning of the light period
between Zeitgeber Time (ZT) 0 and ZT6. Faeces samples were col-
lected at ZT0, ZT12, ZT16, ZT20 and ZT0. Time points of collection
 |
196 of 356       ABSTRACTS
were selected to be reflective of preceding time periods and to take
into account both gastric passage and the decrease in faecal produc-
tion during sleep.
Results: GH and NO sleep-­deprivation protocols did not result in
long-­lasting release of stress hormone, but differentially affected
the acute stress response (p < 0.001). The GH and NO methods both
induced a significant increase of FCM during the light period com-
pared to non-­sleep-­deprived group (p <  0.001). Mice subjected to
GH displayed higher levels of FCM than those sleep-­deprived using
NO (p < 0.001). However, sleep deprivation did not alter the FCM
release during the following dark period.
Conclusions: Considering the intricately linked mechanisms be-
tween sleep loss and stress, acknowledging the influence of sleep-­
deprivation procedures on stress response is crucial. Putative
stress-­associated confounding factors during sleep-­deprivation pro-
tocols could be prevented by minimising or avoiding human inter-
vention and sensory-­motor stimulation.
Disclosure: Nothing to disclose.
P257 | Melatonin and thiobarbituric acid
reactants in menopausal women with insomnia
depending on the genotype of Clock 3111T/C
gene polymorphism
N. Semenova; I. Madaeva; S. Kolesnikov; L. Kolesnikova
Scientific Centre for Family Health and Human Reproduction Problems,
Irkutsk, Russian Federation
Objectives/Introduction: The aim of this study is a comparative
analysis of thiobarbituric acid reactants and melatonin levels in
Caucasian menopausal women with/without insomnia depending
on the genotype of Clock 3111T/C gene polymorphism.
Methods: 214 Caucasian menopausal women divided into control
(without insomnia) and main group (with insomnia) were examined.
Thiobarbituric acid reactants and melatonin levels were determined
by spectrofluorofotometer and immunoenzymometric methods.
The melatonin level in the saliva was determined four times a day
(6:00–7:00, 12:00–13:00, 18:00–19:00, 23:00–00:00 h). The non-­
parametric Mann-­Whitney U-­Test was used to analyze the group dif-
ferences for the independent samples.
Results: Patients with insomnia carriers of the TT-genotype had a
significantly higher thiobarbituric acid reactants and melatonin lev-
els in the early morning hours as compared to group with insomnia
carriers of the minor 3111C- allele (p < 0.05). A comparative analy-
sis of the parameters in the women of the main and control groups
showed higher thiobarbituric acid reactants, morning melatonin and
a lower night melatonin levels in women with insomnia carriers of
the TT-­genotype (p < 0.05). There were no differences in parameters
between main and control groups women -­the carriers of the minor
allele.
Conclusions: Thus, highly toxic products of lipid peroxidation lev-
els and circadian rhythms of melatonin in Caucasian menopausal
women with insomnia depend on the Clock 3111T/C gene polymor-
phism. The minor allele 3111C may have the protective role of in the
development of insomnia and oxidative stress.
Disclosure: The authors report no conflicts of interest.
P258 | Shifts in the circadian rhythm of
children during COVID-­19 pandemic in Poland
and the impact of these alterations on their daily
functioning
M. Kaczor; K. Rogala
Child and Adolescent Psychiatry, Children's Memorial Health Institute,
Warsaw, Poland
Objectives/Introduction: The aim of the study was to assess shifts
in children´s circadian rhythm during the COVID-­19 pandemic re-
sulting from modifications in social functioning, e.g. school closure,
remote teaching, social isolation order, parents’ remote work and
assessment of influence of rhythm changes on subjective daytime
sleepiness, irritation, concentration.
Methods: A circadian rhythm assessment questionnaire was ad-
dressed to parents, comparing children's behaviour and habits
before and during the pandemic. The study was widely promoted
through CMHI website, social media, parents’ support groups.
Changes in functioning before and during COVID-­19 pandemic sta-
tus were assessed in subgroups resulting from the level of education
(preschool, primary school).
Results: 453 questionnaires were submitted. Data from 401 children
was analysed (88,5%). Preliminary analyses present several trends.
When preschools are closed, approx. 30% of children aged 3-­6 (49
people) wake up later and approx. 26% of respondents (43 people)
go to bed later than before the closing period. There is no case of a
child going to bed earlier and only 3 children waking up earlier. At
the same time approx. 51% of children aged 7–14 (100 people) wake
up later and approx. 42% of respondents (100 people) go to bed later
than before the closing period. There is only one case that a child
goes to bed earlier (woman 11 years).
The average total sleep time did not change in preschool group and
increased slightly in school group. There is an increase in the time
spent on the media which is connected with observed irritability in a
group using it more than prior to pandemic. We also noticed increase
in concentration problems in children who did not report such prob-
lems previously.
Conclusions: Life limitations resulting from pandemic COVID -­19
significantly influenced lifestyle of children and their families sleep
being one of the most visible biological changes. Many children de-
layed their bedtime and wake up times, total sleep time of school
children increased in comparison to prepandemic times. It allows to
conclude that children did not spend enough time sleeping before.
ABSTRACTS
However delayed bedtimes resulted in increased irritability and con-
centration problems especially in school aged group.
Disclosure: Nothing to disclose.
P259 | A novel method of detecting the
ballistocardiograph from respiratory inductance
plethysmography signals recorded during sleep
G.H. Olafsdottir; E. Finnsson; D.L. Loftsdottir; S.Æ. Jonsson;
H. Helgadottir; J.S. Agustsson
Nox Research, Nox Medical, Reykjavik, Iceland
Objectives/Introduction: Ballistocardiography (BCG) measures
the movement of the body induced by the heart beating. BCG can
be observed as rhythmic movements of the chest and abdomen.
Respiratory inductance plethysmography (RIP) is used to measure
breathing movements. As RIP technology has improved, a rhythmic
artifact has become increasingly clearer in the RIP signals. We pre-
sent a novel method of detecting these artifacts.
Methods: Overnight thoracic and abdomen RIP signals were re-
corded at 200 Hz, in 105 subjects. The cohort consisted of 56 fe-
males (53.3%), of mean age 50.4 (std = 12.1), and a mean BMI of
28.6 (std = 5.8). Electrocardiography (ECG) was also recorded and R-­
peaks in the ECG were used as a reference to validate the BCG peak
detection. A BCG peak was determined to be a true positive (TP) if
it was within 300 ms of the preceding R-­peak, if more than one BCG
was found after an R-­peak the extra peaks were determined to be
false positives (FP), and if no BCG peak was observed after a R-­peak
a false negative (FN) was marked. The precision, recall, and F1 score
of the BCG detection were calculated. The error in the heart rate
from the BCG compared to the ECG was calculated.
Results: A total of 3,255,381 heartbeats were analysed. The number
of TP BCG peaks were 2,658,992, FP were 596,389, and FN were
624,157. The average precision recall and F1 score were 0.82, 0.81,
0.81 respectively. The median heart rate error was 0.060 beats per
minute (BPM) (IQ r = 4.1559). The median absolute deviation was
1.6110 BPM. The performance was independent of BMI, age, and
sex.
Conclusions: We present a novel method of detecting heart move-
ments from RIP signals recorded during sleep. The results indicate
high performance of the detections. Used in conjunction with the
ECG and/or pulse oximeter pleth signal, the BCG may prove useful in
determining the dynamics of the cardiovascular system during sleep,
such as pulse transit time (PTT).
Disclosure: Nothing to disclose.
|
      197 of 356
P260 | Two main topographic patterns
characterize morning-­to-­evening increases in
low-­frequency brain activity
D. Grollero1; G. Avvenuti1; M. Betta1; B.A. Riedner2; G.
Tononi2; E. Ricciardi1; P. Pietrini1; G. Bernardi1
1
Molecular Mind Lab, IMT School for Advanced Studies Lucca, Lucca,
Italy; 2Dept. of Psychiatry, University of Wisconsin, Madison, WI,
United States
Objectives/Introduction: During wakefulness, variations in brain
‘functional fatigue’ are paralleled by changes in EEG theta-­activity
(4–8 Hz). Indeed, theta-­
power progressively increases during
wakefulness and decreases after a night of sleep; commonly, such
changes are more pronounced over prefrontal areas. However, to
what extent this change may reflect a region-­specific vulnerability
to functional fatigue or rather a greater use/experience-­dependent
build-­up of sleep pressure, remains to be determined. Thus, here
we investigated whether the magnitude of theta-­activity changes
remains topographically stable or displays inter-­session variability.
Methods: Resting-­state hd-­EEG recordings with eyes open (6-­min)
were performed in a single subject (37y/o, male, right-­handed) twice
a day (morning-­
session: 10AM; evening-­
session: 5PM). Nineteen
experimental sessions were completed over a period of 10 months,
during which an actimetry-­sensor was continuously worn. A 10-­min
psychomotor-­vigilance-­test (PVT) was performed after each EEG
recording. All recordings were preprocessed using standard ap-
proaches to reduce artifactual activity. Relative morning-­to-­evening
variations in theta-­power were computed for each electrode and
spatially localized using source-­modeling (sLORETA). A hierarchical
clustering analysis (HCA) was applied to determine whether theta-­
variations were topographically consistent across sessions or pre-
sented multiple possible spatial patterns.
Results: Theta-­power globally increased from morning to evening,
with a peak over frontal electrodes (p < 0.05, cluster-­based correc-
tion). A parallel increase in PVT reaction time was also observed,
though only a weak correlation with theta-­power was found in pa-
rietal channels
(r > 0.47; p < 0.05, uncorrected). HCA revealed two main morning-­to-­
evening theta-­increase patterns. The first pattern (n = 11 sessions)
showed a predominant increase in central-­frontal areas, including
motor/premotor cortical regions, while the second pattern (n = 8 ses-
sions) was characterized by a predominant variation within occipito-­
parieto-­temporal areas. A significant difference between the two
was found over frontal electrodes (p < 0.05, corrected). Interestingly,
pattern-­1 tended to be associated with longer sleep time in the fol-
lowing night, while pattern-­2 tended to be associated with greater
slowing-­down in PVT reaction time (p < 0.1).
Conclusions: These results indicate that morning-­
to-­
evening
changes in low-­frequency activity may actually peak within differ-
ent brain regions. Thus, our findings do not support an inherent vul-
nerability of prefrontal cortical areas but they rather favor a use/
 |
198 of 356       ABSTRACTS
experience-­dependent regulation of EEG-­based indices reflecting
functional fatigue and sleep need.
Disclosure: Nothing to disclose.
P261 | Effectiveness of sodium oxybate in the
prophylaxis of headache and sleep disturbances
in patients with chronic and episodic cluster
headache
Z. Zhang1; A. Gantenbein2; P. Sandor3; R. Agosti4; J.
Petersen5; R. Khatami1
1 of Digestive Tract Diseases, Medical University of Lodz, Lodz, Poland
Sleep Medicine, Sleep Research and Epileptology, Clinic Barmelweid,
2
Barmelweid; Neurology, Reha Clinic Zurzach, Bad zurzach;
3
Neurology, ANNR RehaClinic, Baden; 4Kopfwehzentrum Hirslanden,
Hirslanden Klinik, Zürich; 5Neurology, University Hospital Zurich,
University of Zurich, Zurich, Switzerland
Objectives/Introduction: Cluster headache (CH) is a rare disabling,
often treatment resistant primary headache disorder. Patients pre-
sent with unilateral pain attacks that frequently occur during sleep.
Previous studies provided Class IV evidence that sodium oxybate
(SO) is effective in reducing nocturnal pain attacks in single cases
with intractable chronic CH. Here we aim to assess the effective-
ness of SO therapy for reducing nocturnal pain attacks and improv-
ing sleep in patients with episodic CH (ECH) and chronic CH (CCH) in
a randomized placebo-­controlled trial.
Methods: Patients who had at least four attacks during a 1-­week
baseline period were enrolled in a randomized, placebo-­controlled
multicenter trial. After baseline eligible patients were randomly as-
signed to receive a dosage of 3–9 g SO or placebo. A 2-­week titration
period was followed by a 2-­week stable dose treatment period (W3,
W4). Linear regression analysis controlled for baseline, age and sex
was used.
Results: Eight patients (male n  =  6, female n  =  2, mean age: 40.6y
(range 26y–58y) CCH n  =  6, ECH n  =  2) were enrolled. Three pa-
tients did not finish W4, two of them dropped out due to increased
pain attacks under placebo. We found at stable dosage of SO for
one week (W3) a significantly reduced mean number of nocturnal
attack per night by 0.85 (p = 0.0197) and a trend towards a decrease
in the mean number of attack per 24 h by 1.75 (p = 0.075) in the
treatment group compared to the placebo group. The mean length of
WASO was significantly decreased by about 50 minutes (p = 0.008)
in the treatment group compared to the placebo group. At stable
dosage for two weeks (W4) these effects were no longer significant
(p = 0.195, p = 0.105 and p = 0.627, respectively) in the remaining
patients.
Conclusions: SO administered orally twice at night reduced the fre-
quency of nocturnal attacks and improved nocturnal sleep in a small
number of patients with CCH and ECH as compared to placebo. This
effect was no longer significant at the end of the trial probably due
to the effect of drop-­outs. A larger study with a higher number of
patients is needed to assess the long term effects of SO in ECH and
CCH.
Disclosure: R. Khatami received Speakers honoraria from UCB.
P262 | Determinants of sleep quality in
inflammatory bowel diseases
M. Sochal1; E. Małecka-Panas2; A. Gabryelska1; R.
Talar-Wojnarowska2; B. Szmyd1; M. Krzywdzińska2; P.
Białasiewicz1
1
Department of Sleep Medicine and Metabolic Disorders; 2Department
Objectives/Introduction: Due to the high prevalence of inflamma-
tory bowel diseases (IBD) in developed countries, it is proposed that
such factors as stress, anxiety, or sleep disorders may be important
in the aetiopathogenesis of IBD. Few reports on sleep quality among
IBD patients have been published. However, the causes of disor-
dered sleep in IBD are still poorly understood. The aim of the study
was the analysis of sleep quality in IBD patients and the search for
factors affecting their sleep.
Methods: IBD patients (n  =  137) and healthy control (HC; n  =  60)
were included in the study and completed sleep questionnaires
(Pittsburgh Sleep Quality Index-­PSQI, Athens insomnia scale-­AIS,
Epworth Sleepiness scale-­ESS), Beck Depression Inventory (BDI)
and pain scales (Visual Analogue Scale, Laitinen Pain Scale). Disease
remission was defined as a score below 5 points according to Harvey-­
Bradshaw Index (HBI; for Crohn's disease-­CD) and below 2 points
according to Partial Mayo Score (PMS; for Ulcerative Colitis-­UC).
Results: IBD patients achieved higher scores in all sleep question-
naires compared to HC: PSQI (5, IQR:4–7 vs. 4, IQR:2–6; p < 0.001),
AIS (6.0, IQR:4.0–9.0 vs. 3.0, IQR:1.0–6.4; p < 0.001), and ESS (6,
IQR:4–9 vs. 4, IQR:2–7; p = 0.001). They also had prolonged sleep
latency (15 minutes, IQR:10–30 vs. 10 minutes, IQR:5–15; p = 0.001)
and their sleep efficiency was reduced (88.9%, IQR:83.3–94.6 vs.
97.7%, IQR:92.6–98.3; p < 0.001). HBI was positively associated with
PSQI (r = 0.404, p < 0.001), but not with AIS (r = 0.206, p = 0.087),
nor ESS (r = 0.218, p = 0.070). There were also positive correla-
tions between PMS and PSQI (r = 0.316, p = 0.009), AIS (r = 0.406,
p < 0.001), and ESS (r = 0.285, p = 0.019). Patients with comorbid
chronic diseases (such as asthma, hypertension, migraine, diabetes,
psoriasis) had higher scores in PSQI (p = 0.013), AIS (p = 0.012), but
not in ESS (p = 0.095) compared to others. Multiple regression re-
vealed the sleep questionnaire results were significantly affected
by BDI, but not by the aforementioned pain scales (PSQI: R 2=0.490,
p < 0.001; AIS: R 2=0.440, p < 0.001; ESS: R 2=0.107, p < 0.001).
Conclusions: Sleep impairment in IBD patients is a common problem
that deserves attention in everyday clinical practice and mood level
seems the main factor affecting the quality of sleep in IBD patients.
Disclosure: Funding: National Science Centre, Poland (2018/31/N/
NZ5/03715).
ABSTRACTS
P263 | Sleep and 10 years of aging -­
polysomnography and subjective measures in a
large group of women
T. Åkerstedt1,2; J. Schwarz1,2; J. Theorell-Haglöw3; E.
Lindberg3
1
Clinical Neuroscience, Karolinska Institute; 2Psychology, Stockholm
3
University, Stockholm; Department of Medical Sciences, Respiratory,
Allergy, and Sleep Research, Uppsala University, Uppsala, Sweden
Objectives/Introduction: Sleep problems increase with age and so
do polysomnographical (PSG) measures of poor sleep. These obser-
vations are based on comparisons of age groups, however, and no
longitudinal data are available. The purpose of the present study was
to provide such data, across 10 years of aging in three age groups.
A second purpose was to investigate if changes in reported sleep
problems were reflected in PSG variables.
Methods: The study involved 179 women with two home recorded
sleeps with 10 years in between and divided into the age groups
22–45 years, 46–56 years, and > 56 years.
Results: The results showed that self-­
reported non-­
restorative
sleep (waking up rested, (low) fatigue and sleepiness) (2.62 ± 0.07
to 2.36 ± 0.11, p < 0.001), number of PSG-­recorded awakenings/h
(2.91 ± 0.18 to 2.48 ± 0.12, p < 0.01), sleep latency (19.3 ± 1.8 to
15.1 ± 1.6, p < 0.05) N1% (19.0 ± 0.7 to 17.6 ± 0.7, p < 0.05), and
REM% (18.0 ± 0.5 to 15.9 ± 0.5, p < 0.001) decreased with aging,
while N2% (49.4 ± 0.7 to 51.1 ± 0.6, p < 0.05) and N3% (18.0 ± 0.6 to
15.4 ± 0.6, p > 0.001), and AHI (13.0 ± 1.1 to 16.4 ± 1.3, p < 0.001)
increased. Reported sleep quality (difficulties initiating or maintain-
ing sleep, and early awakenings) did not change. No interaction with
age was significant. The oldest group had the lowest level of non-­
restorative sleep, the shortest TST, the lowest sleep efficiency, the
highest number of awakenings, the longest N3 latency, the highest
N1%, and the lowest REM%. The across years was high for AHI/h,
arousals/h, restorative sleep problems, N3%, N1%, and sleep prob-
lems (all r > 0.50, p < 0.001), suggesting trait-­like properties for these
variables. No correlations were seen between change in PSG vari-
ables and change in sleep ratings. The increase in N3% over time was
accounted for by retirement.
Conclusions: It was concluded that aging 10 years in women im-
proved the perception of restoration by sleep as well as some PSG
indicators of sleep quality, and that interindividual stability in sleep
measures was considerable across time.
Disclosure: Nothing to disclose.
|
      199 of 356
P264 | Age and gender related effects on the
risk for OSA and daytime sleepiness -­a large
population study
S. Demirovic; I. Pavlinac Dodig; L. Lusic Kalcina; R. Pecotic;
M. Valic; Z. Dogas
Department of Neuroscience, University of Split School of Medicine,
Split, Croatia
Objectives/Introduction: Numerous epidemiological studies have
shown the varying prevalence of obstructive sleep apnea (OSA)
among different age groups of the general population, with an in-
creased prevalence in the elderly. Considering the expensive and
time-­
consuming OSA diagnostic procedures, appropriate assess-
ment of the OSA risk with reliable screening tools is essential.
However, age-­related effects on the risk for OSA and one of its hall-
mark features, excessive daytime sleepiness, remain controversial.
Therefore, the aim of this study was to assess the risk for OSA and
daytime sleepiness in a large population sample, with regard to age
and gender.
Methods: A large population sample included 14606 respondents
(45.32% men) from Western Herzegovina, with the median age of
32 (IQR 21–53). The respondents completed STOP questionnaire
for OSA risk assessment and Epworth sleepiness scale for daytime
sleepiness evaluation.
Results: A total of 4273 (29%) respondents had increased risk for
OSA. The risk for OSA increased with age (χ 2=78.35, p < 0.001). Male
respondents had a higher risk for OSA compared to female respond-
ents in younger age groups (up to 70 years) (χ2 = 11.940, p = 0.018),
whereas no difference was found in advanced age group (>70 years).
The proportion of respondents with excessive daytime sleepiness
was significantly higher in participants with increased OSA risk com-
pared to those not at risk, in all age groups (χ2 = 998.36, p < 0.001).
Furthermore, a positive correlation was found between age and day-
time sleepiness in the male respondents (r = 0.042, p < 0.001), but
not in female respondents.
Conclusions: This study performed on a large population sample
demonstrated that the risk for OSA increases with advanced age.
Male respondents had a significantly greater risk than females in all
ages, until the age of 70. Daytime sleepiness was a prominent symp-
tom among subjects with increased OSA risk in all age groups, but
less pronounced in females, emphasizing the influence of gender on
OSA risk and symptomatology.
Disclosure: All authors declare no conflict of interest. The study was
funded by the Croatian Science Foundation grant (TIHO2_SLEEP_
BREATH 5935).
 |
200 of 356       ABSTRACTS

P265 | Heart rate variability during severe OSA had lower HRV based on SDNN (adjusted mean [95%

wakefulness as a marker of obstructive sleep CI]: 37.2 [34.4, 40.1] vs. 46.2 [43.8, 48.6] ms; p < 0.0001), RMSSD
(21.5 [19.5, 23.4] vs. 27.9 [26.3, 29.6] ms; p < 0.0001), pNN50 (5.1%
apnea severity
[3.7%, 6.5%] vs. 9.2% [8.0%, 10.4%]; p = 0.0001), Shannon entropy
(1.83 [1.77, 1.88] vs. 2.01 [1.96, 2.05]; p < 0.0001), and Forbword
H. Qin1; B.T. Keenan2; D.R. Mazzotti2; F. Vaquerizo-Villar3,4;
(36.8 [35.5, 38.1] vs. 33.0 [32.0, 34.1]; p = 0.0001). No significant
J.F. Kraemer5; N. Wessel5; S. Tufik6; L. Bittencourt6; P.A.
differences were found in frequency-­domain measures.
Cistulli7,8; P. de Chazal7; K. Sutherland7,8; B. Singh9,10;
Conclusions: OSA patients showed lower HRV measures during
A.I. Pack11; N.-H. Chen12; I. Fietze1; T. Gislason13,14; S.
wakefulness than individuals without OSA, with severe patients hav-
Holfinger15; U.J. Magalang15; T. Penzel1
1
ing remarkably reduced and less complex HRV measures. Thus, HRV
Interdisciplinary Center of Sleep Medicine, Charité Universitätsmedizin
could provide additional information about cardiovascular physiol-
zu Berlin, Berlin, Germany; 2Division of Sleep Medicine, Department
ogy in OSA patients.
of Medicine, Perelman School of Medicine, University of Pennsylvania,
Disclosure: Nothing to disclose.
Philadelphia, PA, United States; 3Biomedical Engineering
Group, Universidad de Valladolid, Valladolid; 4Biomateriales y
Nanomedicina, (CIBER-­BBN), Centro de Investigación Biomédica
en Red en Bioingeniería, Zaragoza, Spain; 5Department of Physics,
P266 | Is there a difference in
6
Humboldt Universität zu Berlin, Berlin, Germany; Departamento de polysomnographic parameters between shift and
Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil; day workers with insomnia? A subgroup analysis
7
Faculty of Medicine and Health, Charles Perkins Centre, University
of Sydney; 8Department of Respiratory and Sleep Medicine, Royal J. Ell; B. Feige; D. Riemann; K. Spiegelhalder
North Shore Hospital, Sydney, NSW; 9West Australian Sleep Disorders Department of Psychiatry and Psychotherapy Medical Centre,
10
Research Institute, Sir Charles Gairdner Hospital; School of Human University of Freiburg, Freiburg, Germany
Sciences, University of Western Australia, Perth, WA, Australia;
11
Department of Medicine, Perelman School of Medicine, University
12
Objectives/Introduction: Insomnia is a common complaint in shift
of Pennsylvania, Philadelphia, PA, United States; Division of
workers and shift workers with insomnia report similar subjective
Pulmonary, Critical Care Medicine and Sleep Medicine, Chang Gung
13
sleep profiles as day workers with insomnia. To provide a more com-
Memorial Hospital, Taoyuan, Taiwan; Department of Sleep Medicine,
14
prehensive picture of insomnia in shift work this study aimed to ex-
Landspitali University Hospital; Medical Faculty, University of
15
amine differences in objective sleep data between these groups.
Iceland, Reykjavik, Iceland; Division of Pulmonary, Critical Care, and
Methods: The study sample was obtained by reviewing data of
Sleep Medicine, The Ohio State University Wexner Medical Center,
an archival database of the sleep laboratory of the Department of
Columbus, OH, United States
Psychiatry and Psychotherapy, University Medical Centre Freiburg
between 1999 and 2020. Unmedicated individuals fulfilling DSM-­5
Objectives/Introduction: Patients with obstructive sleep apnea criteria for insomnia without any comorbid sleep or psychiatric
(OSA) exhibit heterogeneous heart rate variability (HRV) during disorder were included. Polysomnographic data of 11 shift work-
wakefulness and sleep. We investigated the influence of OSA and its ers including night shifts (18.2% women; mean age 40.7 years) and
severity on HRV parameters during wakefulness in a large interna- 12 shift workers without night shifts (50.0% women; mean age
tional clinical sample. 42.9 years) were identified and compared with data of 23 age-­and
Methods: A total of 1251 subjects (426 without OSA and 825 pa- sex-­matched day workers. Multivariate ANCOVAs controlling for sex
tients with OSA, based on apnea-­hypopnea index ≥ 5) were enrolled were calculated.
from the Sleep Apnea Global Interdisciplinary Consortium. HRV pa- Results: Shift and day workers did not differ in any sleep continu-
rameters were calculated during a 5-­minute wakefulness period with ity variable showing similar total sleep time (F2,42 = 1.46, p = 0.244),
spontaneous breathing prior to the sleep study, using time-­domain, sleep efficiency (F2,42 = 1.27, p = 0.304), sleep onset latency (F2,42 =
frequency-­domain and non-­linear methods. Differences in HRV pa- 0.64, p = 0.530), number of awakenings (F2,42 = 0.64; p = 0.531), wake
rameters were evaluated among groups using analysis of covariance, after sleep onset (F2,42 = 1.36, p =  0.267) and arousal index (F2,40
controlling for age, sex, body mass index, ethnicity, comorbidities = 2.26; p = 0.117). Groups did also not differ in sleep architecture
and site. parameters including the same amounts of stages N1 (F2,42 = 0.35;
Results: Patients with OSA showed significantly lower time-­domain p = 0.710), N2 (F2,42 = 1.06; p = 0.355), N3 (F2,42 = 0.81; p = 0.450) and
variations (SDNN, SDANN1, RMSSD, pNN50) and less complexity of rapid eye movement sleep (F2,42 = 0.83; p = 0.443) as percentage of
heartbeats (Shannon entropy, Fwshannon, Forbword) when compared sleep period time. Moreover, sleep perception defined as difference
to individuals without OSA. Those with severe OSA had remarkably between objectively measured and subjectively experienced total
reduced HRV compared to all other groups, both in time-­domain and sleep time did not differ between groups (F2, 37 = 1.30; p = 0.286).
non-­linear measures. Compared to non-­OSA patients, those with
ABSTRACTS
Conclusions: Shift workers with insomnia seem to present a poly-
somnographic sleep profile similar to that of day workers with insom-
nia. Future studies might investigate more systematically the effects
of first-­line insomnia treatment on shift workers with insomnia.
Disclosure: Nothing to disclose.
P267 | Music intervention for insomnia
disorder: a randomized controlled trial
K.V. Jespersen1; M. Otto2; M. Kringelbach3; E. Van
Someren4,5; P. Vuust1
1
Department of Clinical Medicine, Aarhus University; 2Department of
Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark;
3
Department of Psychiatry, University of Oxford, Oxford, United
Kingdom; 4Netherlands Institute for Neuroscience; 5Departments of
Integrative Neurophysiology and Psychiatry, VU University and Medical
Center, Amsterdam, The Netherlands
Objectives/Introduction: Music is often used as sleep aid by people
with insomnia, and commercial products are widely available. Yet,
research in this field has been scarce, and the existing studies suffer
from substantial risk of bias and lack of objective sleep measures.
To account for these shortcomings, we conducted a randomized
controlled trial evaluating the effect of bedtime music listening for
improving sleep in adults with insomnia disorder.
Methods: Fifty-­seven participants with insomnia disorder were ran-
domized to music intervention, audiobook control or waitlist control
group in this three-­armed, assessor-­blinded RCT. Participants in the
music group could choose between four slow music playlists of dif-
ferent genres and a similar approach was used for the audiobook
group. Both groups received an audio player designed to be used
in bed during the three-­week intervention period. The primary out-
come was insomnia severity and secondary outcomes included qual-
ity of life as well as objective sleep measured with actigraphy and
polysomnography.
Results: Time by group interactions only approached significance
for the primary outcome measured by the insomnia severity index
(effect size = 0.71, p = 0.06), even though within group comparisons
showed a significant reduction in insomnia symptoms in the music
group, but not in any of the control groups. Participants in the music
group had improved quality of life compared to the two control
groups (effect size = 0.61, p = 0.01), but we saw no effect of the
music intervention on objective sleep measures.
Conclusions: In contrast to previous studies, our results did not
show a clear effect of the music intervention on insomnia symptoms
and sleep quality. This difference may relate to differences in par-
ticipant characteristics, study design and the music intervention.
Importantly, we did see improved quality of life in the music group
suggesting that music as sleep aid may also improve daytime func-
tioning. Future studies should clarify the effect of music in insomnia
|
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subgroups and address the potential mechanisms underlying any ef-
fect of music on sleep.
Disclosure: The study was funded by Trygfonden. None of the au-
thors report any conflicts of interest.
P268 | The effects of cognitive behavioural
therapy for insomnia on cognitive functioning in
youths
J. Ling1; N.Y. Chan2; J. Zhang3; S.P. Lam2; A.M. Li4; Y.K.
Wing2; C.A. Espie5; S.X. Li1,6
1
Psychology, The University of Hong Kong; 2Psychiatry, The Chinese
University of Hong Kong; 3Guang Dong Mental Health Center,
Guangdong Provincial People's Hospital, Guangdong Academy of
Medical Sciences; 4Paediatrics, The Chinese University of Hong Kong,
Hong Kong, Hong Kong; 5Sleep and Circadian Neuroscience Institute
(SCNi), Nuffield Department of Clinical Neurosciences, Sir William
Dunn School of Pathology, University of Oxford, Oxford, United
Kingdom; 6The State Key Laboratory of Brain and Cognitive Sciences,
The University of Hong Kong, Hong Kong, Hong Kong
Objectives/Introduction: Insomnia is the most prevalent sleep prob-
lem in youths, often associated with subjective cognitive complaints
and some aspects of objectively measured performance deficits.
Current evidence supports the efficacy of cognitive behavioural
therapy for insomnia (CBT-­I) on improving sleep, but its effects on
cognitive functioning remains under-­studied, especially among the
youths. This study aimed to examine the effects of CBT-­I on cogni-
tive functioning in youths.
Methods: 147 youths aged 12–24 years (M = 19.87, SD = 2.49)
with DSM-­5 insomnia disorder were recruited from two clinical tri-
als (ClinicalTrials.gov Identifier: NCT03438331; NCT03522701).
Participants were assigned to either eight weekly sessions of group-­
based CBT-­I treatment (n  =  67) or waitlist control group (n  =  80),
and were assessed at baseline and post-­treatment by self-­reported
questionnaires and a battery of cognitive tests, including Digit Span
task and N-­back task for working memory, Go/No-­go task for inhibi-
tive control, Wisconsin Card Sorting task for mental flexibility, and
Trail Making Task for set shifting. Linear mixed models were used to
examine the effects of treatment on sleep and cognitive outcomes,
controlling for age, gender, and depression.
Results: Participants who received CBT-­
I intervention had im-
proved sleep (Insomnia Severity Index, ISI, F = 14.44, p < 0.001,
Cohen´s d = 1.66) and self-­perceived cognitive abilities (Cognitive
Failure Questionnaire, F = 5.5, p = 0.02, Cohen's d = 0.36). There
was a significant group × time interaction effect on the Trail Making
task, TMT, Time B: F = 4.32, p = 0.039, Cohen's d = 0.63). No signifi-
cant treatment effect was found on other tasks. Mediation analysis
showed that change in ISI mediated the treatment effect on sub-
jective cognitive functioning (indirect effect size  =  −3.21, 95% CI:
−6.44, −0.57).
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202 of 356       ABSTRACTS
Conclusions: Our findings suggested that CBT-­
I improved self-­
perceived cognitive functioning and some aspects of objectively
measured executive function in youths. Future studies should in-
vestigate the long-­term impacts of insomnia treatment on cognitive
functioning in youths.
Disclosure: Nothing to disclose.
P269 | Long working hours are significantly
associated with frequent insomnia symptoms in
the UK Biobank
N. Walter; K. Spiegelhalder
Department of Psychiatry and Psychotherapy, University of Freiburg,
Germany, Freiburg, Germany
Objectives/Introduction: The aetiology of insomnia is poorly under-
stood. In particular, little is known about the association between
work-­related variables and the development of insomnia. This inves-
tigation analysed the association between long and short working
hours and insomnia symptoms in a large cross-­sectional dataset.
Methods: This study is based on an analysis of the UK Biobank (first
assessment visit), a large population-­based sample of adults aged
40–69 yrs. A logistic regression model was used to examine the im-
pact of short (< 35 hours) and long (>40 hours) working hours on
insomnia symptoms using age, sex, socioeconomic status, education,
and depressive symptoms as covariates.
Results: The overall sample for the analysis included 267,097 partici-
pants (24.3% with frequent insomnia symptoms; 33.4% with short
working hours; 27.3% with long working hours). Long working hours
were significantly associated with frequent insomnia symptoms
(beta = 0.067, p < 0.001), while there was no significant association
between short working hours and frequent insomnia symptoms
(p = 0.658).
Conclusions: Long working hours might play a role for the develop-
ment and maintenance of insomnia and should be further investi-
gated using longitudinal designs.
Disclosure: Nothing to disclose.
P270 | Insomnia mediates the relationship of
occupational stress with depression, anxiety and
burnout among shift working nurses
1 2 1
K. Gustavsson ; A. Wichniak ; W. Jernajczyk
1
Department of Clinical Neurophysiology, Sleep Medicine Center;
2
Third Department of Psychiatry, Institute of Psychiatry and Neurology,
Warsaw, Poland
Objectives/Introduction: Insufficient sleep increases sensitivity to
chronic stress and may be a precursor of deterioration of mental
health and burnout development. The aim of our study was to verify
whether symptoms of insomnia mediate the relationship between
occupational stress and mental health and burnout among shift-­
working nurses.
Methods: We gathered responses from 122 female shift work-
ing nurses with at least 1 year of work experience. They filled in
Insomnia Severity Index (ISI), Patient Health Questionnaire (PHQ-­
9, question about sleep was excluded from analyses), Generalized
Anxiety Disorder Assessment (GAD-­7), 16-­item Oldenburg Burnout
Inventory (OLBI) consisting of two scales -­Disengagement and
Exhaustion (OLBI-­
D and OLBI-­
E) and 16-­
item Effort-­
Reward
Imbalance Questionnaire (ERI) assessing occupational stress.
Results: Data analysis was done with the PROCESS v3.4 macro in
SPSS. Number of work hours per week, nights per month, cigarettes
per day were not significantly correlated with the outcome variables.
Age, amount of caffeine per day, work and shift work experience
were significantly correlated with the dependent variables, but were
not significant covariates in the mediation models. ISI was not sig-
nificantly correlated with OLBI-­D (p = 0.651), therefore was not con-
sidered as a mediator in the relationship between ERI and OLBI-­D.
ERI was significantly associated with PHQ (B = 4.5043, SE = 0.9136,
p < 0.0001), GAD (B = 5.3886, SE = 0.9415, p < 0.0001) and OLBI-­E
(B = 2.886, SE = 0.6802, p < 0.0001) and insomnia (B = 3.0567,
SE = 0.9398, p = 0.0015). Insomnia mediated the effects of ERI on
PHQ (95% CI [0.3089, 2.2438]), GAD (95% CI [0.1907, 2.0602]), and
OLBI-­E (95% CI [0.0591, 1.1458]).
Symptoms of insomnia accounted for 25.12% of the total effect of
ERI on PHQ, 17.27% of the total effect of ERI on GAD, 18.45% of the
total effect of ERI on OLBI-­E.
Conclusions: The results show that occupational stress has varying
degrees of influence on mental health depending on the severity of
insomnia symptoms among shift working nurses.
Disclosure: The research is supported by a grant no. 2019/33/N/
HS6/02572 from the National Science Center in Poland.
P271 | Trazodone changes REMS structure and
transiently prevents short-­term memory decline
and hypothalamic neuroinflammation in a mouse
model of dementia
P. de Oliveira1,2; K.A. Wafford2; G. Gilmour2; D.J. Dijk1,3; R.
Winsky-Sommerer1
1
Surrey Sleep Research Centre, University of Surrey, Guildford; 2Eli Lilly
& Company, Windlesham; 3UK Dementia Research Institute, University
of Surrey, Guildford, United Kingdom
Objectives/Introduction: Sleep disturbances are common neu-
ropsychiatric symptoms of dementia. Sleep continuity disruption
and reduction in rapid eye movement sleep (REMS) have shown
to exacerbate disease progression in Alzheimer's disease (Winsky-­
Sommerer et al., 2019), but effective therapeutic interventions to
ABSTRACTS
alleviate sleep-­wake disturbances, cognitive decline and neuropa-
thology in dementia are lacking. Trazodone, a commonly used an-
tidepressant, delayed tau progression in the rTg4510 mouse model
of frontotemporal dementia (Halliday et al., 2017), and protected
neuronal-­like cells from inflammatory insult (Daniele et al., 2015).
The current study aimed to characterise the effects of chronic tra-
zodone administration on sleep, behaviour and neuropathological
hallmarks in rTg4510 mice.
Methods: Two parallel groups received daily intraperitoneal injections
of trazodone (40 mg/kg, n = 7) or placebo (n = 5) (males, from 4-­to
8-­
months-­
old). Continuous electroencephalography (EEG)/electro-
myography (EMG) recordings were collected. Short-­term memory was
assessed by the Olfactory Discrimination Test at baseline, 4-­and 16-­
week of treatment. Hypothalami were collected at baseline and after
8-­and 16-­week of treatment for immunohistochemistry analyses of
hyperphosphorylated tau (bAT8, 1:4000) and microglial activation
(anti-­IBA1, 1:4000). Data were analysed using a linear mixed model.
Results: Trazodone induced an increase in 24 h-­REMS duration from
7-­weeks of treatment (p = 0.0100), while no effect was observed on
total sleep time or non-­REMS (p = 0.4983 and p = 0.4518, respec-
tively). This effect was accompanied by an increase in REMS bout
count per 24 h after 6-­weeks of treatment (p = 0.0147), without any
significant changes observed in REMS bout duration (p = 0.2134). A
decrease in relative EEG theta power density during REMS (5.1–9 Hz)
was observed from 3-­weeks of treatment (p = 0.0006) compared to
placebo. Trazodone prevented olfactory memory deficits after 4-­
weeks compared to placebo (p = 0.0090), but not after 16-­weeks
of treatment. Task performance was negatively correlated to REMS
EEG theta power (Pearson's r  =  −0.6407, p = 0.0337). While trazo-
done prevented microglial activation in the hypothalamus after 8-­
weeks compared to placebo (p = 0.0496), no effect was seen after
16-­weeks (p = 0.4683). Trazodone had no effect on hypothalamic
atrophy (p = 0.9077) and tau immunoreactivity (p = 0.5235).
Conclusions: Trazodone prevented REMS-­related disturbances and
temporarily slowed down memory decline and hypothalamic neu-
roinflammation in the rTg4510 mouse line. This process appears to
occur without delaying tau pathology and atrophy.
Disclosure: Paula de Oliveira is sponsored by the Godfrey Blott PhD
Studentship in conjunction with the University of Surrey and Eli Lilly
& Co. Ltd.
P272 | Interrelationships of organisational
commitment, self-­control and sleep among
working adults
A. Zavadska1; K. Hallmann2
1
Institute of Psychology; 2Institute of Sport Economics and Sport
Management, German Sport University Cologne, Cologne, Germany
Objectives/Introduction: Sleep, human's most unfulfilled need,
often gets neglected, which can lead to fatal consequences. In hope
|
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to foster good sleep hygiene among working adults, the interrela-
tionships between organisational commitment, subjective norms,
perceived behavioural control, intentions and sleep were inves-
tigated. The study focused on finding out to what extent working
adults attain the recommended amount of sleep and to what extent
highly committed employees attain a better sleep hygiene. It was
assumed that the higher the organisational commitment (OC), the
better the sleep hygiene will be in working adults and in contrast,
the lower the organisational commitment, the lower the self-­control
in obtaining the recommended amount of sleep.
Methods: Since OC has not yet been explicitly associated with sleep,
a cross-­sectional study using an online survey was conducted with
working adults.
Results: Results from a sample of 303 working adults (age:
M =  41.21 years; job length: M = 90.31 months) showed a good fit
(chi-­square = 94.669, df = 59, p = 0.002, normed chi-­square = 1.605,
CFI = 0.923, RMSEA = 0.065, LCL = 0.039, UCL = 0.088, pclose = 0.155,
SRM r = 0.0813). The structural equation model also revealed a sig-
nificant positive direct influence of subjective norms on intentions to
attain recommended hours of sleep (ß = 0.469; p = 0.015) and a sig-
nificant positive direct effect of perceived behavioural control on inten-
tions (ß = −0.298; p = 0.002). Using the bootstrap method with 1,000
re-­samples, a significant positive indirect effect of organisational com-
mitment on intentions was observed at standardised bootstrap esti-
mate (bias-­corrected; SBE (BC) = −0.053, p = 0.048).
Conclusions: The findings were only partly consistent with previ-
ous literature because OC did not have a significant effect on sleep.
However, self-­control played a key role in intention to obtain good
sleep hygiene. The insignificant effect of intentions on sleep can be
explained by the existence of the intention-­behaviour gap, meaning
that solely a simple plan to perform an action is not sufficient to
result in a desired behaviour. Therefore, employers should focus on
fostering individual self-­control and creating achievement-­oriented
work environment in hope to increase organisational commitment.
Disclosure: Nothing to disclose.
P273 | Intrinsic organization of fMRI networks
during sleep and its relevance to dreaming
A. Tarun1,2; L. Perogamvros3,4; D. Van De Ville1,2; V.
Sterpenich4; S. Schwartz4
1
Institute of Bioengineering and Center for Neuroprosthetics, École
Polytechnique Fédérale de Lausanne; 2Department of Radiology and
Medical Informatics, University of Geneva; 3Department of Medicine,
Geneva University Hospitals; 4Department of Basic Neurosciences,
University of Geneva, Geneva, Switzerland
Objectives/Introduction: In this work, we employed a novel method
to extract intrinsic functional networks (i.e. innovation-­driven co-­
activation patterns (iCAPs)) that rely on transients
(i.e., moments of activity changes) in fMRI data, in order to relate
their activity to simultaneously acquired EEG data during quiet
 |
204 of 356       ABSTRACTS
wakefulness and NREM sleep. Using the EEG power-­spectrum, we
also aimed to recover which of these large-­scale functional net-
works underlie dreaming when the condition of low delta and high
beta/gamma power in posterior regions is satisfied, according to the
literature.
Methods: Functional data were obtained using a 3T Siemens MRI
scanner. There were a total of twenty-­
six healthy participants
(22.1 ± 2.4 yo), who were asked to rest until they fall asleep inside
the scanner. During the whole scan, a simultaneously 64-­channel
EEG recording was obtained. We applied state-­of-­the-­art sparsity-­
pursuing deconvolution, termed total activation, to the whole time-­
course, to extract functional brain networks that undergo consistent
transitions from wakefulness to deep sleep (iCAPs). We then looked
at the correlation between the iCAPs timecourses and the EEG
power-­
spectrum across the 64 channels. Finally, we determined
which networks are activated when a simultaneous low-­delta and
a high beta/gamma (taking the lower 15% and upper 85% percentile
respectively) is observed in a posterior cluster.
Results: There were 17 spatial brain patterns (iCAPs) that predomi-
nantly occurred across wakefulness and deep sleep. The prefron-
tal iCAP appeared highly correlated with left cortical regions during
wakefulness, whereas the visuospatial iCAP displayed correlations
with occipital regions for all sleep stages. Averaging significant corre-
lations across all iCAPs revealed a general peak at 8.75 Hz in N2 sleep.
When the dream criterion was satisfied, the precuneus, followed by
the limbic/subcortical (including the anterior cingulate cortex, thala-
mus and cerebellum) and visual-­sensory iCAPs, were highly occurring.
Conclusions: We observed intrinsic functional networks with dis-
tributed spatial patterns and whose activity time-­courses have dis-
tinct EEG correlates for each sleep stage. Notably, we observed a
peak correlate at 8.75 Hz for a huge majority of the networks during
stage 2 sleep. We also found, for the first time, an fMRI network cor-
respondence of EEG correlates of dreaming, namely the precuneus,
limbic/subcortical networks, and visual-­sensory areas.
Disclosure: Nothing to disclose.
P274 | How Somno-­Art software fills the gap
between actimetry and polysomnography in
accurately and efficiently characterizing sleep
L. Thiesse; G. Fuchs; D. Kirscher; V. Dehouck; J.-Y.
Schaffhauser; A.U. Viola
PPRS Research, Colmar, France
Objectives/Introduction: Actimetry is widely used as an alternative
to gold standard polysomnography (PSG) for assessing objectively
sleep in large or long-­term studies. However, actimetry doesn't allow
to reach by no mean the level of sleep exploration achieved by PSG. A
lot of research efforts have been put, over the last decade, in coming
up with algorithms aiming to achieve sleep architecture and continu-
ity as close as PSG evaluation. We here present the performances of
the Somno-­Art Software (SASoftware) in comparison to actimetry
and PSG in healthy and pathological subjects.
Methods: Eighteen nights from healthy subjects, 14 from insom-
niac, 33 from depressed and 15 from obstructive sleep apnea (OSA)
patients were analyzed. PSG recordings were scored by experts
following the AASM guidelines. Wrist activity was measured and an-
alyzed with ActiGraph LLC. SASoftware was used to assess sleep pa-
rameters from synchronized heart rate and wrist activity. Intra-­class
correlation (ICC) was used to determine the agreement between the
devices (PSG vs SASoftware; PSG vs actimetry; SASoftware vs ac-
timetry) on the overall group. Mixed-­model analysis were performed
for each sub-­group. Statistical significance was set at p < 0.05.
Results: On the overall group, ICC was excellent for total sleep time
(TST), sleep efficiency (SE) and wake after sleep onset (WASO) be-
tween PSG, SASoftware and actimetry. ICC of sleep onset latency
(SOL) was good for PSG-­SASoftware and poor for PSG-­actimetry and
SASoftware-­actimetry. ICC of light, deep and REM sleep for PSG-­
SASoftware were respectively fair, good and excellent. Looking at
sub-­groups, TST and SE were correctly detected with actimetry and
SASoftware in healthy subjects. Unlike SASoftware, actimetry over-
estimated TST and SE in depressed and OSA patients. In insomniacs,
SASoftware's estimation of TST and SE was in-­between PSG and ac-
timetry estimations (SASoftware-­actimetry: p < 0.05; actimetry-­PSG:
p < 0.05; SASoftware-­PSG: p < 0.05). Actimetry systematically under-
estimated SOL, while SASoftware was consistent to PSG. WASO was
correctly estimated by actimetry and SASoftware.
Conclusions: Overall, SASoftware is more consistent then actimetry
in characterizing sleep structure of healthy and pathological sub-
jects. Furthermore, SASoftware discriminates sleep stages similarly
to PSG. These results place SASoftware as a valuable alternative
to PSG to accurately assess key sleep parameters with minimum
constraints.
Disclosure: The authors are employees or shareholders of PPRS re-
search, the developer of Somno-­Art Software.
P275 | Towards a handy screening tool for REM
sleep behaviour disorder: RDBAct algorithm from
wrist actigraphy data
C. Moerman1,2; F. Raschellà1,2; P.-E. Nunes-Ferreira3; C.
Ferlito3; E. Martin-Moraud1,2; A. Puiatti4; P.-L. Ratti5
1
Department of Clinical Neurosciences, Centre Hospitalier Universitaire
Vaudois (CHUV); 2Defitech Center for Interventional Neurotherapies
(NeuroRestore), CHUV-­EPFL, Lausanne; 3Neurocenter of Southern
Switzerland, Lugano; 4Department of Innovative Technologies,
University of Applied Sciences and Arts of Southern Switzerland,
Manno, Switzerland; 5dell'Angelo Hospital | Department of Neurology,
ULSS 3 Serenissima, Venice, Italy
Objectives/Introduction: A screening tool for REM sleep behav-
iour disorder (RBD) alternative to nocturnal video-­polysomnography
ABSTRACTS
(video-­PSG) is a major need for both research and clinical purposes.
Actigraphy, recording acceleration from wrist-­worn devices, could be a
handy and relatively inexpensive tool. Here, we aimed to develop new
algorithms to automatically classify Parkinson's patients exhibiting REM
sleep without atonia (RSWA) based on actigraphic recordings only.
Methods: Twenty-­five patients with Parkinson's Disease (7 females,
67.0 ± 9.8 year-­old) underwent two full-­night video-­PSG coupled
with bilateral wrist actigraphy. Recordings with (n = 31) or without
(n = 18) phasic RSWA were identified by inspecting video-­PSG re-
cordings. For each recording (~8 h duration), tri-­axial accelerometer
signals were filtered and used to compute movement amplitudes.
Movement episodes were identified by thresholding (threshold = 3
times the standard deviation of the full signal), and each episode was
parameterised into 6-­dimensional feature-­vectors that accounted
for aspects such as movement duration, maximal amplitude, dura-
tion of the resting-­time preceding the episode, etc.
Results: We reasoned that differences between RBD and non-­RBD
patients would be captured by the way movements are distributed
in the parametrised space. To capture such differences, we first pro-
jected movement feature-­vectors into a lower-­dimensional space
using principal component analysis (PCA). The first component alone
accounted for ~40% of explained variance. We then quantified the
way movements are distributed along that component by computing
the percentage of movements falling on one or the other side of a
threshold that we optimised to maximise the differences between
the two groups. 6-­fold cross-­validation analyses, iteratively trained
on a dataset of size = 42 recordings and tested on a group of size = 8
recordings, achieved a median performance of 67% (10 repetitions,
p = 0.002 for this median to be different from chance-­level, Mann-­
Whitney test) as quantified by the area under the curve of the ROC.
Conclusions: These preliminary results put forward the possibility to
distinguish subjects with RBD based on simple wrist actigraphy. Future
direction will be to extend this method to patients with isolated RBD
and discriminating RBD from other sleep disorders with motor mani-
festations, such as sleep disordered breathing or nocturnal seizures.
Disclosure: Nothing to disclose.
P276 | Evaluating a multi-­sensor approach for
assessing sleep using wearable and smartphone
technology
X.Y. Chua; S.A.A. Massar; A. Ng; J.L. Ong; C.S. Soon; N.I.Y.N.
Chee; M.W.L. Chee
Centre for Sleep and Cognition, National University of Singapore,
Singapore, Singapore
Objectives/Introduction: The proliferation of wearable and smart-
phone technology has enabled continuous monitoring of sleep using
data from different channels (physiological [wearables], behav-
ioural [phone usage] and ecological momentary assessment [EMA
self-­report]). As these use different information to assess sleep,
|
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information gaps suggested by discrepancies between estimates
may be filled in through cross-­referencing of measures for an over-
all more accurate sleep measurement. We evaluated the utility of
using multiple data sources for sleep detection during the COVID-­19
lockdown, when normal social cues and routines were disrupted and
gave rise to greater variation in sleep patterns.
Methods: 198 staff and students from the National University of
Singapore (61 male, mean age 26.15 ± 5.83 years) were recruited for
an 8-­week study. Data from the first 5 weeks are reported here. Sleep
timings were assessed daily from three channels: a wearable sleep and
activity tracker (Oura ring), estimations from smartphone touchscreen
interactions (tappigraphy) and smartphone derived EMA self-­reports.
Results: Completion rates for wearable, tappigraphy, and self-­report
data collection were 90.8%, 88.4% and 87.8% respectively. Across par-
ticipants, a minimum of two sleep measures were recorded on 94.4%
of 5117 potential nights (73.8% with all three measures). Pairwise cor-
relations between each measure with the mean of the other two meas-
ures revealed values of R ≥ 0.71, p < 0.001 for bedtime, and R ≥ 0.69,
p < 0.001 for wake time. T-­tests revealed that relative to self-­reports,
Oura-­derived bed and wake times tended to be later (M = 9.90mins,
SD = 43.27mins and M = 17.6mins, SD = 54.56mins respectively),
and tappigraphy-­
based bedtimes (but not wake time) were earlier
(M = 9.79mins, SD = 86.77mins). Sleep estimates across the three meth-
ods showed high overall agreement, with some discrepancies: Relative
to matched self-­report data, Oura tended to give a later wake time
readout while tappigraphy estimates of bedtime tended to be early.
Conclusions: We show here that the combined use of three streams of
data concerning sleep can provide redundancy that covers for lapses in
reporting, a problem that plagues longitudinal time series data collec-
tion. With continued data acquisition, adjustment through triangula-
tion and resolution of discrepancies across measures may also be used
to improve the accuracy of such sleep assessment affording more ac-
curate correlation between sleep and health variables of interest.
Disclosure: This research was supported by the National Medical
Research Council (STaR19may-­0 001).
P277 | Sleep-­wake cycle disturbances are
exaggerated by epileptiform activity in early
period of traumatic brain injury in rats
A. Volkova1,2; I. Komoltsev1,3; M. Novikova1; N. Gulyaeva1,3
1
Functional Biochemistry of Nervous System, Institute of Higher
Nervous Activity and Neurophysiology, Russian Academy of Sciences,
Moscow, Russia; 2Neurology, Neurosurgery and Medical Genetics n.a.
Badalyan, Pirogov RNRMU; 3Moscow Research and Clinical Center for
Neuropsychiatry, Moscow, Russian Federation
Objectives/Introduction: Sleep disturbances are common sequelae
of traumatic brain injury (TBI) aggravating patient's quality of life.
Epileptiform activity, cortical and hippocampal damage are involved
in putative mechanisms of these pathologies. The study aimed to
 |
206 of 356       ABSTRACTS
assess epileptiform activity in background and in early period of
TBI with respect to sleep abnormalities and pathomorphological
changes in the neocortex and hippocampus.
Methods: The study was performed on 18 adult male Sprague-­
Dawley rats: shams and two TBI groups -­with or without elevation
of epileptiform discharges (EDs) after TBI. ECoGs were recorded
7 days before craniotomy and 7 days after severe TBI (lateral fluid
percussion of the right sensorimotor cortex). Morphological changes
were evaluated by Isolectin B4 (microglial marker) and GFAP (astro-
glial marker) staining.
Each ED episode was attributed to awakening, transition to NREM
sleep, NREM sleep or REM sleep. Power spectral density was as-
sessed for each phase of sleep-­wake cycle.
Results: TBI induced a decrease in proportion of REM sleep from
9.2 ± 0.4 in background to 4.9 ± 0.5% (p < 0.01) on day 1 and to
5.6 ± 0.3% (p < 0.01) on day 7. During REM sleep, the power spec-
trum shifted to lower frequency region, while the maximum ampli-
tude of the spectrum decreased.
Rats with ED after TBI as compared with rats without EDs had lower
proportion of wakefulness (from 0.49 ± 0.04% vs 0.51 ± 0.04% in
background to 0.42 ± 0.04% vs 0.51 ± 0.04% on day 1, 0.53 ± 0.14%
vs 0.59 ± 0.13% on day 6, < 0.05) and increased proportion of NREM
sleep (0.40 ± 0.03% vs 0.39 ± 0.04%, 0.52 ± 0.03% vs 0.43 ± 0.07%,
0.41 ± 0.14% vs 0.34 ± 0.12%, respectively, p < 0.05).
In the ipsilateral cortex, the area of astroglial activation positively
correlated with the number of epochs with EDs. In the hippocampus,
microglial density in polymorph layer of the dentate gyrus (poDG)
was higher in rats after TBI as compared to shams and the contralat-
eral hippocampus and did not correlate with EDs after TBI.
Conclusions: TBI modifies sleep architecture, most significantly
in rats with EDs, the incidence of EDs positively correlating with
astroglial activation in the neocortex. Supported by RFBR grant
#19-­015-­0 0258
Disclosure: Nothing to disclose.
P278 | The emission of 22 kHz vocalizations
during REM sleep in the rat
1 1,2 1 1 1
F. Squarcio ; M. Cerri ; T. Hitrec ; M. Luppi ; D. Martelli ;
A. Occhinegro1; E. Piscitiello1; D. Tupone1; R. Amici1
1
Department of Biomedical and Neuromotor Sciences, University of
Bologna; 2National Institute for Nuclear Physics, INFN, Bologna, Italy
Objectives/Introduction: Adult rats emit two main types of ul-
trasonic vocalizations: the 22 kHz calls express distress, while the
50 kHz calls express positive states. We recorded the emission of
vocalizations at 22 kHz in a study regarding the wake-­sleep pattern
in obese rats, in order to monitor animal well-­being. Since, unexpect-
edly, vocalizations also occurred during REM sleep, we proceeded to
a quantitative analysis of these events.
Methods: Fifteen male Sprague-­Dawley rats, adapted to a 12 h:12 h
Light-­Dark (L-­D) cycle (L: 09:00 h–21:00 h) were fed for eight weeks
either a Normocaloric (N, n = 7) or a Hypercaloric (35% of fat) (H,
n = 8) diet, leading to develop obesity (26% increase in body weight).
Under general anaesthesia, animals were implanted with electrodes
for electroencephalography, and nuchal and diaphragmatic elec-
tromyography. After a one-­week post-­operative recovery, animals
underwent two days of baseline recording, and then, during the L
period of the third day, they were totally sleep deprived by gentle
handling. The 22 kHz vocalizations were recorded by means of a
‘Bat Detector’. Similarly to what observed during Wakefulness, dur-
ing REM sleep vocalizations typically occurred in series of several
events. Thus, for each animal both i) the relative number (No./h of
REM sleep), and ii) the series duration were assessed during both the
L (rest) and D (activity) phases, and the 12 h-­recovery period (REC)
following sleep deprivation.
Results: Both the number of the series (mean±SEM: NL = 2.8 ± 2.1;
ND = 1.8 ± 2.3; NREC = 2.4 ± 2.8; HL = 2.6 ± 3.9; HD = 2.2 ± 1.5;
HREC = 1.8 ± 2.1), and the series duration (s, mean±SEM: NL = 7.7 ± 6.5;
ND = 12.8 ± 9.1; NREC = 8.4 ± 6.9; HL = 11.2 ± 11.05; HD = 10.1 ± 6.4;
HREC = 8.6 ± 3.1) did not show any statistically significant effects due
to either the ‘experimental time’ (L, D, REC) or the ‘animal weight’ (N,
H) conditions by two-­way ANOVA for repeated measures analysis.
Conclusions: The appearance of ultrasonic vocalizations during REM
sleep appears to be a REM sleep constitutive phenomenon, and not
to be influenced by either possible respiratory pathophysiological
process developed in obese rats or stress accumulated during sleep
deprivation.
Disclosure: Nothing to disclose.
P279 | Does sleep restriction affect learning
from positive or negative feedback?
A. Gerhardsson1,2; D.K. Porada3; J.N. Lundström3,4,5; J.
Axelsson1,2,3; J. Schwarz1,2,3
1
Department of Psychology; 2Stress Research Institute, Stockholm
University; 3Department of Clinical Neuroscience, Karolinska Institute,
Stockholm, Sweden; 4Monell Chemical Senses Center, 5Department of
Psychology, University of Pennsylvania, Philadelphia, PA, United States
Objectives/Introduction: To learn from positive or negative feed-
back (trial and error) is vital when no prior information is available.
Sleep deprivation has been found to reduce the sensitivity to feed-
back in general. However, there might also be a difference between
learning from positive and negative feedback as previous research
shows increased reward-­hypersensitivity and reduced risk-­aversion
after sleep deprivation. The aim of the present study was to inves-
tigate if sleep restriction alters the tendency to learn from positive
and negative feedback in a probabilistic selection task (PST).
Methods: Thirty-­two participants (Mage = 29.0, 18 women) were tested
once after (i) normal sleep and once after (ii) two nights of partial sleep
ABSTRACTS
restriction (4 hours) in a crossover design. The PST consists of two
phases. During a learning phase, the participant is presented with
three pairs of ambiguous symbols, out of which one symbol is mostly
associated with positive feedback, and the other one mostly with
negative feedback. In a subsequent test phase, the pairs are scram-
bled and feedback is removed. We evaluated win-­stay/lose-­shift ten-
dencies and learning rate of the learning phase. In the test phase we
investigated whether the individual prioritized learning from positive
(choosing the symbol with the highest probability of reward) or nega-
tive feedback (avoiding the symbol with the highest probability of pun-
ishment). We used Bayesian generalized mixed-­effects models with
Bayes Factors (BF) indicating level of evidence for the experimental
hypothesis over the null (BF10) or reversed (BF01), where a BF above 3
is considered equivalent to a p-­value below 0.05.
Results: Despite a twofold increase in sleepiness (Karolinska
Sleepiness Scale: BF10 = 1 + e07), evidence indicated no effect of
sleep restriction on win-­stay (BF01 = 127) or lose-­shift tendencies
(BF01 = 108) or on generalized learning from positive (BF01 = 7.54) or
negative (BF01 = 9.39) feedback. However, the results suggest a slow-
ing of learning speed for negative feedback (First block: BF10 = 3.40,
All blocks: BF10 = 196), and less difference in learning rate between
positive and negative feedback after sleep restriction (First block:
BF10 = 6.36, All blocks: BF10 = 7.35).
Conclusions: These results may indicate a reduced short-­term sen-
sitivity to negative feedback after sleep restriction, which stabilizes
over a rather short period of time.
Disclosure: Nothing to disclose.
P280 | Cognitive deficits under total sleep
deprivation with and without coffee: differential
contribution of sleep debt and time on task
M. Quiquempoix1,2; M. Erblang1,2; A. Vergez1; P. Van
Beers1,2; M. Guillard1,2; M.C. Erkel1,2; C. Drogou1,2; D.
Léger2,3; M. Chennaoui2,4; F. Sauvet1,2; A. Rabat1,2
1
Unité Fatigue et Vigilance, Institut de Recherche Biomédicale des
Armées, Brétigny sur Orge; 2EA 7330 VIFASOM, University of Paris;
3
Hôpital Hôtel Dieu/AP-­HP, Centre du Sommeil et de la Vigilance,
4
Paris; Division Santé du Militaire en Opération, Institut de Recherche
Biomédicale des Armées, Brétigny sur Orge, France
Objectives/Introduction: Mental fatigue, a decreased capacity due to
a long-­lasting involvement in a cognitive task (time on task-­TOT)[1], is
involved in accidents[2] that are also observed with sleepy subjects
(total sleep deprived-­TSD)[3]. TOT and TSD may thus operate inde-
pendently[4] or synergistically[5] to build up mental fatigue and that
remains a key question. By using caffeine, an antagonist of adenosine
receptor (A1 and A2A) able to reduce deficits related to TSD (i.e. sleep-
iness, sustained attention deficits)[6], we sought to determine poten-
tial interactions between TOT and TSD effects on cognitive processes.
|
      207 of 356
Methods: 24 right-­
handed and healthy subjects (18–50 years
old), with a median chronotype and sleep need participated in a
2-­experimental counter-­balanced (placebo: PBO and caffeine: CAF
-­2.5 mg/kg) total sleep deprivation protocol (TSD = 27 hours of
continuous wakefulness). Subjective sleepiness (KSS), sustained at-
tention (PC-­PVT), inhibition (Go/No-­Go) and working memory (2N-­
Back) capabilities were tested each morning during BASE and TSD
(10 min. test session from 9:15 am to 10:15 am). Caffeine was in-
gested with a decaffeinated drink at 8:30 am.
Results: As expected, sleepiness (KSS: 5.6 ± 0.4-­TSD vs 3.2 ± 0.3-­
BASE; p < 0.001) and cognitive deficits were significantly higher
after TSD compared to BASE (PVT/Number of Lapses: 9.8 ± 1.7 vs
0.4 ± 0.2; p < 0.001; No-­Go Errors: 6.4 ± 0.4 vs 3.1 ± 0.3; p < 0.01).
But we also observed a TOT effect during TSD on number of Lapses/
min. (PCBO-­TSD7-10 min=1.28 ± 0.18 vs PCBO-­TSD0-3 min=0.65 ± 0.17;
p < 0.05), on No-­Go errors ratio (PCBO-­TSD7-10 min=8.2 ± 1.3% vs
PCBO-­TSD0-3 min=3.7 ± 0.6%; p < 0.001) and on 2N-­Back correct re-
sponses (CR: PCBO-­TSD7-10 min=87 ± 2% vs PCBO-­TSD0-3 min=92 ± 1%;
p < 0.05). Furthermore, caffeine only and partially reduced number of
Lapses/min. (CAF-­TSD = 5.8 ± 0.4 vs PCBO-­TSD = 9.8 ± 1.7; p < 0.01)
without having any beneficial effects on No-­Go errors ratio (p > 0.09),
on 2N-­Back CR and although no effect on TOT observed during TSD.
Conclusions: Our results are in accordance with previous studies show-
ing sustained attention (SA) and executive deficits related to TSD[7].
They also agree with previous ones showing benefit of caffeine on SA
and no effect on executive ones[8]. Finally, our results claim for differ-
ent psychophysiological mechanisms related to TOT and to TSD.
Support: Grants from the French General Directorate for Armament
(# Contract: SAN-­1-­509).
Keywords: TSD, TOT, Sustained attention, Inhibition, Working
Memory, Caffeine.
Disclosure: Nothing to disclose.
P281 | Compliance of postural sleep apnea
patients with a new forehead vibratil device.
Data not show
L. Hidalgo Armas1; S. Inglés2; R. Vaca1; J. Cordero Guevara3;
J. Durán Carro2; J. Ullate2; F. Barbe 4; J. Duran Cantolla1,2,4
1
Servicio de Investigación; 2Unidad de Trastornos del Sueño; 3Unidad de
Metodología y Estadistica, Instituto de Investigación Sanitaria Bioaraba,
Vitoria; 4CIBER de Enfermedades Respiratorias, ISCIII, Madrid, Spain
Objectives/Introduction: In 56–75% of patients with obstructive
sleep apnea (OSA), the frequency of apneas and hypopneas are in-
fluenced by body position, also around 25% of OSA patients have
supine isolated OSA in the supine position.
We previously showed, in a RCT, a reduction of apnea-­hypopnea
index (AHI) of 34% using the device. At present the outcome was to
show the compliance, number of device activations and the related
postural changes, once starting treatment in each week.
 |
208 of 356       ABSTRACTS
Methods: This is a multicenter, randomized, prospective, parallel
controlled trial. The sample was performed by patients > 18 years,
diagnosed as positional OSA. The follow-­up was 12 weeks.
Results: The median use of the device was similar in both groups
throughout the 12 weeks (p > 0.05 in all weeks, except in week 11,
p = 0.048), with variations between 6.5 (3.3) (week 3) and 7.3 hours
(1.8) (week 9) in the inactive device group (ID) and between 6.4 (1.8)
(week 4) and 7.0 (1.5) (week 9) in the active device (AD).
The median percentage of time in the supine position was signifi-
cantly lower in AD group compared to ID throughout 12 weeks
(p < 0.012 in all weeks), in spite of the similar time of use. Also, since
the first week the difference of time spent in supine position is note-
worthy, reaching a total of 10.6% (14.8) total sleep time in supine
position with ID vs. 2.6% (4.2) with AD.
The median percentage of time in supine during follow-­up showed
a significant decrease. Moreover this trend can be showed in all of
weeks reaching at 12 weeks a difference of 7.2% (p < 0.001).
The number of activations in AD group and the activations related
to a postural change showed non-­significant variations between 0.7
and 1.0 (p = 0.802) and 4.1 and 5.4 (p = 0.929) respectively, through-
out the monitoring, indicate a sustained effect over time.
Conclusions: The compliance of active device is high and a signifi-
cant reduction in the supine position took place. A conditioned re-
flex, avoiding the supine position from the start, could be explained
by a constant effect of the device over time.
Disclosure: Nothing to disclose.
P282 | Ambulatory circadian monitoring in
sleep disordered breathing
A. Martinez-Nicolas1,2; M. Guaita3; J. Santamaria4; J.M.
Montserrat5,6; J.A. Madrid1,2; M.A. Rol1,2
1
Chronobiology Lab, Department of Physiology, College of Biology,
University of Murcia, Mare Nostrum Campus, IUIE, IMIB -­Arrixaca,
Murcia; 2Ciber Fragilidad y Envejecimiento Saludable (CIBERFES),
Madrid; 3Multidisciplinary Sleep Disorders Unit, Hospital Clinic of
Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer
(IDIBAPS); 4Multidisciplinary Sleep Disorders Unit and Neurology
Department, Hospital Clinic of Barcelona, Institut d'Investigacions
Biomèdiques August Pi i Sunyer (IDIBAPS); 5Multidisciplinary Sleep
Disorders Unit and Pneumology Deparment, Hospital Clinic of Barcelona,
Barcelona; 6Ciber Enfermedades Respiratorias (CIBERES), Madrid, Spain
Objectives/Introduction: Our aim was to evaluate by Ambulatory
Circadian Monitoring (ACM) the circadian rhythms of wrist temper-
ature (WT), activity, position and integrated variable TAP in Sleep
Disordered Breathing (SDB) and the effect of continuous positive
airway pressure (CPAP) on the circadian rhythms in order to predict
the pathological states.
Methods: We monitored WT, activity and position rhythms of 78 SDB
patients (53.3 ± 1.2 years old, 26.9% women) and 32 healthy subjects
(51.4 ± 3.2 years old, 43.8% women) for one week. On the last day of
that week, SDB patients underwent a polysomnography. A subgroup
of 18 moderate to severe SDB patients was treated with CPAP and
monitored again after 3 months. Circadian patterns were characterized
using a non-­parametrical analysis followed by a ROC curve analysis to
assess differences between groups and ACM usefulness as screening
tool. Values of p < 0.05 were considered to be statistically significant.
Results: SDB patients compared to healthy subjects exhibited alter-
ations in WT stability (0.35 ± 0.01 vs 0.59 ± 0.01, p < 0.001), ampli-
tude (0.17 ± 0.01 vs 0.30 ± 0.02, p < 0.001), robustness (0.46 ± 0.01
vs 0.60 ± 0.01, p < 0.001) and daytime values (33.42 ± 0.05ºC vs
32.89 ± 0.08ºC, p < 0.001), and in TAP stability (0.56 ± 0.01 vs
0.73 ± 0.01, p < 0.001) and robustness (0.64 ± 0.01 vs 0.74 ± 0.01,
p < 0.05). CPAP treatment improved SDB patients’ amplitude
(0.68 ± 0.02 vs 0.59 ± 0.03, p < 0.05), fragmentation (0.72 ± 0.03
vs 0.78 ± 0.04, p < 0.05) and nocturnal values (12.10 ± 1.30 a.u. vs
18.40 ± 1.72 a.u., p < 0.01) for the activity pattern. Finally, circadian
parameters allow to accurately detect SDB patients and CPAP ther-
apy effect with an 89.2% and 86.7% of agreement rate, respectively.
Conclusions: Circadian variables were altered in SDB. The activity
pattern improved with CPAP. Thus, TAP could be used to evaluate
the circadian alterations caused by SDB and activity pattern to mon-
itor the improvement of CPAP treatment.
Acknowledgments: Supported by CB16/10/00239, 19899/
GERM/15 awarded to JAM, RTI2018-­093528-­B-­I00 to MAR and
CB06/06/0025 to JMM (all of them FEDER co-­funded).
Disclosure: Nothing to disclose.
P283 | Interdisciplinary weight loss and
lifestyle intervention for obstructive sleep
apnoea in adults: The INTERAPNEA randomized
controlled trial
A. Carneiro-Barrera1; F.J. Amaro-Gahete2,3,4; L. Jurado-
Fasoli2,3; A. Guillén-Riquelme1; G. Sáez-Roca5; C. Martín-
Carrasco5; J. R. Ruiz3; G. Buela-Casal1
1
Sleep and Health Promotion Laboratory, Mind, Brain and Behaviour
Research Centre (CIMCYC), University of Granada, Granada, Spain;
2
EFFECTS-­262 Research Group, Department of Medical Physiology,
School of Medicine; 3PROmoting FITness and Health through Physical
Activity Research Group (PROFITH), Sport and Health University
Research Institute (iMUDS), Department of Physical Education and
Sports, Faculty of Sport Sciences, University of Granada, Granada;
4
Department of Health, Camilo José Cela University, Madrid; 5Unidad
de Trastornos Respiratorios del Sueño, Servicio de Neumología, ‘Virgen
de las Nieves’ University Hospital, Granada, Spain
Objectives/Introduction: Obesity is the core risk factor of ob-
structive sleep apnoea (OSA), the most common sleep disordered-­
breathing related to cardio-­metabolic and neurocognitive disorders,
impaired daily functioning and mood, and vehicle/occupational
ABSTRACTS
accidents. Although widely recommended, there are no studies on
the effectiveness of an interdisciplinary weight loss and lifestyle
intervention including nutrition, exercise, sleep hygiene, and smok-
ing and alcohol cessation for OSA in adults. We therefore aimed to
elucidate the effects of an eight-­week interdisciplinary weight loss
and lifestyle intervention on apnoea-­hypopnoea index (AHI, main
outcome) in overweight-­obese adults with moderate-­severe OSA.
Methods: The INTERAPNEA study, a randomised controlled
trial with a two-­arm parallel design, included 89 men aged 18–65
(54.1 ± 8 years) with a body-­mass index (BMI) ≥ 25 kg/m2 (34.4 ± 5.4)
and severe-­moderate OSA (41.3 ± 22.2 apnoea-­hypopnoea/h), ran-
domly assigned to usual care (continuous positive airway pressure,
CPAP), or interdisciplinary weight loss and lifestyle intervention
combined with CPAP. The intervention included weekly 60–90 min
group-­based sessions of nutritional behaviour change, supervised-­
exercise, sleep hygiene, and active alcohol and tobacco cessation.
Outcomes were measured at baseline and intervention end-­point in-
cluding apnoea-­hypopnoea index (AHI), oxygen desaturation index
(ODI), other neurophysical and cardiorespiratory polysomnographic
outcomes, sleep quality, daily functioning and mood, body weight
and composition, physical fitness, and health-­related quality of life.
Results: Significant improvements on AHI (−21.15 ± 10.85) and ODI
(−15.99 ± 14.98) were found in the intervention group (n = 42) with
a 7% mean body-­weight reduction (−7.1  ±  3.8  kg) (all p < 0.001),
whereas no differences were noted in the control group (AHI,
2.8 ± 8.6; ODI, 3.24 ± 11.42; body-­weight, −0.2 ± 2.9; all p > 0.05).
Large standardized effect sizes/mean differences on AHI (d = −1.08;
95% CI, −1.19 to −0.97) and ODI (d = −0.80; −0.89 to −0.72) were
found. At intervention end-­point, AHI from the intervention group
was 52.13% lower compared to baseline. Remarkably, remission of
OSA was consistently found in 34.15% of patients who no longer
required CPAP-­use. Secondary outcomes were also significantly im-
proved after intervention.
Conclusions: INTERAPNEA is the first study including a highly effec-
tive interdisciplinary weight loss and lifestyle intervention for OSA.
It may therefore serve to establish an effective treatment not only
for the improvement of OSA and its vast and severe comorbidities,
but also for a potential remission of this condition.
Disclosure: This research is supported by the Spanish Ministry
of Education and Vocational Training, grant/award number
FPU16/01093. The study is also partially supported by the Sleep
Research Cathedra University of Granada-­
LoMonaco S.L.; the
University of Granada Plan Propio de Investigación 2016 -­E xcellence
actions: Unit of Excellence on Exercise and Health (UCEES); and
the Junta de Andalucía, Consejería de Conocimiento, Investigación
y Universidades (European Regional Development Funds, ref.
SOMM17/6107/UGR). The authors declare no conflict of interest.
|
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P284 | Adding nocturia to STOP-­Bang
questionnaire -­would it improve OSA diagnosis
accuracy?
J. Borges1; K. Lopes2; J.C. Costa1; M.F. Teixeira3; J. Moita3
1
Pneumology Unit, Centro Hospitalar Universitário Coimbra, Coimbra;
2
Pneumology Unit, Centro Hospitalar Barreiro Montijo, Lisboa; 3Sleep
Medicine Center, Centro Hospitalar Universitário Coimbra, Coimbra,
Portugal
Objectives/Introduction: Obstructive sleep apnea (OSA) is a com-
mon disease with high morbidity and mortality burden.
Though prevalent, moderate-­severe OSA may be underdiagnosed.
Accurate and user-­friendly screening tools are vital to identify pa-
tients at risk. Also a common symptom, frequency of nocturia is
thought to be associated with severe OSA.
We aim to predict OSA and moderate-­severe OSA probability by
adding the nocturia variable to the STOP-­Bang questionnaire.
Methods: Retrospective study of patients observed in our sleep
clinic who had undergone polysomnography and completed STOP-­
Bang questionnaire.
Results: Of the 284 patients reviewed (71,1% males,
54,54 ± 12,23 years, body mass index (BMI) 31,61 ± 14,02 kg/m2),
83,8% have OSA of which 34,9% are moderate and 35,7% severe.
A logistic regression was performed to determine OSA probability
using STOP-­Bang+nocturia model, which correctly classified 89,1%
cases (vs 85,9% with classic STOP-­
Bang). Tiredness (p = 0.014),
observed apnea (p = 0.043), age > 50 (p = 0.001), neck circum-
ference > 40 (p = 0.007), male gender (p = 0.025) and nocturia
(p = 0.001) added significance to the model, whilst snoring, high
blood pressure and BMI did not. Higher number of nocturia events
was associated with a slight increase in OSA probability.
Using STOP-­
Bang+nocturia for prediction of all, moderate-­
severe and severe OSA, the area under the ROC curve was 0.897
(IC95%:(0.855; 0.839), p < 0.001), 0.823 (IC95%:(0.774; 0.872),
p < 0.001) and 0.804 (IC95%:(0.752; 0.856), p < 0.001). For classic
STOP-­Bang ROC was 0.857, 0.811 and 0.778, respectively.
With a STOP-­Bang+Nocturia score ≥ 2, the sensitivity was 99.6% for
all OSA and 100% for both moderate-­severe and severe OSA.
Conclusions: Adding nocturia to the STOP-­Bang questionnaire had
high sensitivity, not only for all OSA but mostly for moderate-­severe
and severe OSA. Also, this model was more accurate classifying OSA
patients, particularly moderate-­severe and severe OSA.
We believe these results suggest this score may be a powerful tool
in reducing underdiagnosed OSA, along with a helpful stratification
score in the initial evaluation of patients with suspected OSA.
Disclosure: Nothing to disclose.
 |
210 of 356       ABSTRACTS
P285 | Changes in anxiety and depression
levels in couples of patients with sleep apnea
after one year of CPAP therapy
I. Portela Ferreño1; J. Gonzalvez Rey2; A. Piñeiro Lopez3; T.
Rivera Baltanas4; M. Mosteiro Añon5; A. Fernandez Villar6
1
TRS-­Neumología, Hospital Universitario Alvaro Cunqueiro de Vigo;
2
Medicina de Familia, Centro de Salud de Teis; 3Urgencias/Medicina
Deportiva, Hospital Alvaro Cunqueiro de Vigo; 4Enfermedades
Neuropsiquiátricas, Fundacion Biomedica Galicia Sur; 5TRS-­ Neumología;
6
Neumología, Hospital Alvaro Cunqueiro de Vigo, Vigo, Spain
Objectives/Introduction: To assess the emotional changes in cou-
ples of SAHS patients after one year of using CPAP.
Introduction: Couples of patients suffering from Obstructive Sleep
Apnea Syndrome (SAHS) perceive their relationships more stressful
and their perception of leisure and enjoyment is less. Sleeping next
to someone who snores is not only annoying, but also unhealthy.
Methods: Longitudinal comparative study of 102 pairs of patients
with possible SAHS diagnosis from January 2018 to October 2019.
After performing respiratory polygraphy and diagnosis of medium-­
severe SAHS with prescription of CPAP, adherence to treatment and
hours of use were monitored for part of the patient. To continue in
the second phase of the study, it was necessary to use CPAP over
4 hours/day by the patients and that their respective partners did not
have psychotropic guidelines. So the N decreased to 62. Female cou-
ples 85.7%. The mean age was 48.60 ± 8.99 for couples. Emotional
variables were analyzed through the HAD questionnaire (depression
and anxiety) and we also included a Likert scale of impact of SAHS in
pairs created by the research team. For the statistical processing and
analysis of the data, the SPSS program was used.
Results: After a year of CPAP therapy, the couples showed a decrease
in the levels of Anxiety and Depression, respectively (p < 0.01). 90%
of couples reported that the use of CPAP by patients has greatly
helped to improve their own state of health highlighting the non-­
interruption of their sleep due to snoring of the patient.
Conclusions: Couples after one year of CPAP treatment showed im-
provement in their mood. The results obtained suggest that treating
the patient improves the quality of sleep for both.
Disclosure: Nothing to disclose.
P286 | Objective and subjective sleep quality
in individuals experiencing recurrent isolated
sleep paralysis
M. Kliková1,2; K. Janků1,2; E. Miletínová1,2; D. Urbaczka
Dudysová1,2; J. Bušková1,2
1
National Institute of Mental Health, Klecany; 23rd Faculty of
Medicine, Charles University, Prague, Czech Republic
Objectives/Introduction: Previous research has shown a link be-
tween decreased subjective sleep quality and sleep paralysis.
Unfortunately, compared to the research on subjective sleep meas-
ures, a sparse amount of studies have measured sleep objectively.
Therefore, the present study aimed to assess both subjective and
objective sleep quality in individuals who experience recurrent iso-
lated sleep paralysis (RISP) and to evaluate whether subjective sleep
changes are consistent with objective findings.
Methods: A total sample of 38 participants were included in the pre-
sent study. Nineteen participants with at least 2 RISP episodes in the
last 6 months were compared with a group of 19 healthy participants
without RISP experience. To exclude narcolepsy, participants with RISP
completed multiple sleep latency tests. All participants underwent ad-
aptation and experimental night of video-­polysomnography record-
ings (PSG), including 19-­channel electroencephalography. The primary
outcomes were total sleep time (TST), sleep onset latency (SOL), wake
after sleep onset (WASO), and sleep efficiency (SE). Participants were
asked to estimate their TST and SOL in the morning. To assess the dif-
ference between objective and subjective sleep parameters, differen-
tial values for TST, and SOL (objective TST/SOL -­subjective TST/SOL)
were computed. The Pittsburgh Sleep Quality Index (PSQI) was used
to assess overall sleep quality in the preceding month.
Results: Participants with RISP reported significantly lower overall
sleep quality on PSQI (6.16 ± 2.83) compared to the control group
(3.89 ± 1.72; p = 0.007). Significant differences were found in the fol-
lowing PSQI components: Subjective sleep quality (p = 0.013), Sleep
duration (p = 0.025), Sleep disturbance (p = 0.018), and Daytime dys-
function (p = 0.007). However, there was no significant difference
in any of the subjective and objective sleep continuity parameters
(SOL, TST, WASO, and SE) between groups. Both groups evaluated
their TST, and SOL accurately compared to PSG.
Conclusions: Although individuals with RISP showed decreased
overall sleep quality in the last month compared to the control
group, the PSG and subjective estimates of sleep parameters com-
parison did not reveal any differences. Both groups estimated their
sleep accurately compared to PSG. [MK1] [VK2] Longitudinal studies
using both subjective and objective sleep measures (e.g., using actig-
raphy) may be beneficial to further explore the overall sleep quality
in individuals experiencing RISP.
Disclosure: Nothing to disclose.
P287 | Is RSBD ‘protective’ against severe OSA?
K. Lopes1; J. Borges2; M.F. Teixeira3; J. Moita3
1
Pneumology Unit, Centro Hospitalar Barreiro Montijo, Lisboa;
2
Pneumology Unit; 3Sleep Medicine Center, Centro Hospitalar
Universitário Coimbra, Coimbra, Portugal
Objectives/Introduction: Some authors have defended that REM
sleep behavior disorder (RSBD) may have a ‘protective’ role in the
severity of Obstructive Sleep Apnea (OSA).
ABSTRACTS
We intend to explore the link between these entities and whether
RSBD improves Apnea-­Hypopnea index (AHI).
Methods: In this case-­control study, clinical and polysomnographic
characteristics of RSBD-­OSA were matched with similar OSA con-
trols. Differences in sleep structure and AHI severity were analyzed
by SPSS 22.0.
Results: We studied 52 RSBD-­
OSA patients (84,6% males) with
67,83 ± 12,54 years and body mass index 28,06 ± 3,90 kg/m2.
Compared with OSA controls, RSBD-­
OSA have less severe AHI
(20,83 ± 16,08/h vs 31,18 ± 16,18/h; p = 0,001), namely in REM
sleep (16,48 ± 13,25/h vs 33,98 ± 16,65/h; p=< 0.001) and NREM
(17,16 ± 13,19/h vs 30,72 ± 18,35/h; p=< 0.001). Furthermore,
among moderate-­
severe OSA, 5/30 RSBD-­
OSA have REM-­
AHI
higher than NREM-­AHI against 20/43 OSA controls.
Apart from differences in N1, the sleep structure was similar, namely
in REM sleep duration. Periodic limb movements were more fre-
quent in RSBD-­OSA (27,08 ± 36,99/h vs 10,79 ± 14,83/h; p = 0,005).
More RSBD-­
OSA have degenerative diseases, namely Parkinson
Disease (15,4% vs 3,8%; p = 0,046).
Although arousals were lower in RSBD-­OSA (24,98 ± 14,38/h vs
39,35 ± 15,29/h;p=< 0.001), sleep efficiency and wake after sleep
onset time were similar.
Overall, RSBD-­OSA has reduced odds for moderate-­severe OSA (OR
0,26; CI 0.11–0.65).
Conclusions: This study is consistent with the hypothesis that RSBD
may have influence in AHI of moderate-­severe OSA, mainly due to
the absence of atonia during REM-­sleep that characterizes this dis-
order. Even so, AHI in NREM sleep was also significantly reduced.
We questioned whether sleep structure differed between the
groups and impact sleep efficiency and consequently AHI severity.
Despite lower arousals and higher PLMS in RSBD-­OSA, there were
no significant differences in these sleep features.
The answer to these questions may hinge on the poorly understood
neurophysiopathology of this neurodegenerative disease.
Disclosure: Nothing to disclose.
P288 | The multimodal complex nocturnal
visual hallucinations
V. Gnoni1,2; I. Duncan3; A. Birdseye3; D. Wassermann3; S.
Higgins3; P. Drakatos3; M. Koutroumanidis4; A. Nesbitt3; G.
Leschziner3; I. Rosenzweig1,3
1
Department of Neuroimaging, Institute of Psychiatry, Psychology
& Neuroscience, King's College London; 2Guy's and St Thomas’ NHS
3
Foundation Trust, Sleep Disorders Centre; Guy's and St Thomas’ NHS
Foundation Trust, Sleep Disorders Center; 4Guy's and St Thomas’ NHS
Foundation Trust, Department of Neurology, London, United Kingdom
Objectives/Introduction: Complex nocturnal visual hallucinations
(CNVH) are sparsely reported benign parasomnia phenomenon,
which occurs following a sudden awakening from sleep without
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recall of a preceding dream (ICSD-­3). They are considered to be a dis-
tinct form of simple sleep-­related hallucinations, thought to be more
prevalent in patients suffering with neurodegenerative disorders.
Methods: A retrospective analysis of clinical and video-­
polysomnographic findings of patients diagnosed with NREM para-
somnia between 9/2017 and 5/2020 at a tertiary sleep centre was
undertaken. 28 patients (mean age 31.9 ± 5.7 years) who concomi-
tantly presented with NREM parasomnia and multimodal CNVH
were identified. Further comprehensive review of these cases was
undertaken.
Results: In the majority of patients, classical NREM parasomnia
features were recorded during VPSG investigations. All patients
described past nocturnal experiences of distinct episodes of seeing
mobile or immobile shapes, objects, people or shadows of people,
animals and insects (particularly spiders). Dysmetropsia was similarly
commonly experienced, and hallucinations tended to disappear with
increased illumination. The rich CSRH phenomenology included ex-
tracampine hallucinations, as well as more subtle experiences of loss
of thought ipseity and spatialization of experience (the sense that
thought has spatial or dimensional qualities). Six patients reported
experiencing CNVH during the VPSG, and in all six, a shared dis-
tinct pattern consisting of initial arousal, characterised by a sudden
shift of EEG-­frequencies including ongoing delta/theta and alpha-­
rhythms, coinciding with eye-­opening, and a short delay before the
abrupt raising of the head and trunk, was observed. Subsequently,
a diffuse alpha-­rhythm was recorded, and patients were observed
as being awake, staring at a point in the room or visually tracking,
before returning to NREM sleep.
Conclusions: CNVH are a peculiar sleep phenomenon, as of yet
poorly understood. Multimodal perceptual fragmentation with
figure-­ground confusion and loss of perceptual stability, with ob-
jects appearing to change shape or appearance can be frightening
and worrying to the patient and their families. We argue that CNVH
may represent a distinct form of sleep-­wake dissociation in NREM,
which is due to dysregulation of gating of the production of visual
internal image associated with a possible disinhibition of the visual
and other associative sensory cortices.
Disclosure: Nothing to disclose.
P289 | Mortality in patients with NREM
parasomnias in the Danish population
N. Suhak1; P. Jennum1,2
1
Danish Center for Sleep Medicine, Department of Clinical
Neurophysiology, Rigshospitalet; 2Faculty of Health Sciences,
University of Copenhagen, Copenhagen, Denmark
Objectives/Introduction: Non rapid eye movement (NREM) para-
somnias are relatively benign conditions, especially in childhood,
but in adults they can lead to injury of the sleeper and bed partner
and may be associated with other sleep disorders and with different
 |
212 of 356       ABSTRACTS
somatic disorders. It has not yet been sufficiently investigated if
mortality rate in NREM parasomnia patients are higher than in gen-
eral population. We evaluated the mortality in a national group of
patients for 11 years observation period.
Methods: All patients in Denmark with a diagnosis of NREM par-
asomnia between 2006–2016 were identified from the Danish
National Patient Registry records. There were 1.505 NREM paras-
omnia patients in age from 0 to over 80 years. 907 (60,3%) patients
were males, 597 (39,7%) patients were females. Comparative analy-
sis was performed using 6.017 randomly chosen controls matched
for age, gender, geography and marital status (marital status of chil-
dren was matched marital status of the parents).
Results: 84% (0.84, 95% CI: 0.81–0.87) of NREM parasomnia patients
were still alive in 2016 compared with 91% (0.91; 95% CI: 0.90–0.92)
of controls. Thus, there was significant difference in the mortality
rate of patients with NREM parasomnia compared with the matched
controls during the observation period (Hazard Ratio = 1.86; 95% CI:
1.55–2.24; χ² = 0.00).
Conclusions: We found, that a diagnosis of NREM parasomnia was
associated with increased mortality during the observational period
11 years in Danish cohort of patients, which contradicts to the previ-
ous assumption. We think, that this association is not random. The
purpose of our further investigations is to find a possible explanation
for this phenomenon using comparative analysis of morbidity and
the courses of death, which can potentially contribute to a develop-
ment of better preventive measures.
Disclosure: Nothing to disclose.
P290 | Different effects of various blue
enriched light regimes on wakefulness, wellbeing,
and attention in sleepy and non-­sleepy industrial
shift workers
A. Rodenbeck1,2; A. Wiater2
1
Pneumology, Evangelisches Krankenhaus Goettingen-­Weende,
Goettingen; 2Pediatrics, Krankenhaus Porz am Rhain, Koeln, Germany
Objectives/Introduction: Bright and/or blue light has been shown
to improve alertness in experimental settings. Field studies are lim-
ited and focus on night shifts. We therefore studied various light
regimes in industrial workers in a morning and evening shift system.
The study was granted by the Federal Ministry of Education and
Research.
Methods: Insomnia (ISI), sleepiness (ESS), mood (non verbal face
scale), sleep duration, actual wakefulness, light comfort, participants
global impression of change (PGI), and objective attention (d2 test)
and sleepiness (pupillography, PUI) were measured during the even-
ing shifts (5 pm to 10 pm) after 2 or 3 weeks of the following light
regimes: baseline (BL, 5000 K, 120 mlux), L1 (2700 K, 122 mlux), L2
(5000 K, 213 mlux), L3 (dynamic setting: 7000 K at morning -­2700 K
in the evening), L4 (7000 K, 400 mlux). Light was continuously
given during morning and evening shifts, excepted the dynamic L3.
Statistical analysis was based on repeated t-­tests.
Results: Out of 91 participants (4 females) 72 completed at
least baseline and one other session. 21 workers showed an ESS
index > 10 (mean 13.2) at baseline. In these workers ESS improved in
all settings (p < 0.05) excepted L3, but remained pathological, mood
increased significantly under L2 and L3, PUI following L3, and ISI and
actual alertness at L4 (p < 0.05 each). The non-­sleep group showed
no changes for any of these parameters. In contrast, the increase
of attention was more pronounced in the non-­sleep group. During
all sessions ESS, ISI, mood, PUI, attention, and wakefulness of the
sleepy group were worse than the non-­sleepy group's.
Conclusions: Although ESS improved significantly under blue en-
riched light, they remained worse in the sleep group. Also all pa-
rameters were worse than the non-­sleepy one's. Nevertheless, the
improvements by light were more pronounced in the sleepy group,
excepted attention. Sleepiness should be a crucial factor in further
studies on the effects of light and/or effects of shift work.
Disclosure: Nothing to disclose.
P291 | Inter-­and intra-­subject variability of N2
sleep spindles during daytime naps
A. Visalli1,2; D. Bergamo1,3; N. Cellini1,4,5
1
Department of General Psychology; 2Department of Neurosciences,
University of Padova, Padova; 3MOMILAB Research Unit, IMT School
for Advanced Studies Lucca, Lucca; 4Department of Biomedical
Sciences; 5Padova Neuroscience Center, University of Padova, Padova,
Italy
Objectives/Introduction: Sleep spindles are an electrophysiological
feature of NREM sleep consisting of short bursts of oscillatory ac-
tivity in the frequency range of 9–16 Hz originated in the reticular
thalamus), which are thought to be implicated in sleep regulation and
memory consolidation. Growing evidence has shown the existence
of two types spindles which differ in frequency and topography:
slow spindles (< 12 Hz) more pronounced over frontal cortical sites,
and fast spindles (>12 Hz) more pronounced over centro-­posterior
sites. Sleep spindles have shown strong individual night-­to-­night sta-
bility. Although the majority of spindle studies have been focused
on full-­night sleep, spindle activity is observed also during daytime
naps. Here, we mainly investigated the nap-­to-­nap reliability of spin-
dle peak frequency.
Methods: Participants were twenty healthy students (F = 9;
Age = 24.4 ± 1.9y). Electroencephalographic (EEG) recordings from
two daytime naps separated by seven days were scored according
to standard criteria. Artifact free stage 2 NREM sleep (N2) epochs
were subjected to spectral analysis (Welch's method) and peaks in
the 9–16 Hz frequency range were extracted. Nap-­to-­nap reliability
was assessed using Intraclass Correlation Coefficient (ICC).
ABSTRACTS
Results: Peak frequency of slow spindles over frontal electrodes
showed low nap-­to-­nap reliability (F3: ICC = 0.52; Fz: ICC = 0.44; F4:
ICC = 0.62). Overall mean peak frequency was higher than what is
usually observed during night sleep (mean = 12.7 Hz, SD = 1.27 Hz).
Conversely, peak frequency of fast spindles over centro-­posterior
electrodes showed very high nap-­to-­nap reliability (C3: ICC = 0.88;
C4: ICC = 0.87; P3: ICC = 0.94; P4: ICC = 0.91; O1: ICC = 0.93; O2:
ICC = 0.89). Fast spindle peak frequency had an overall mean of 14.1
(SD = 0.6 Hz), consistently with what is usually observed during noc-
turnal sleep. Moreover, it showed less inter-­subject variability com-
pared to the peak frequency of slow spindles (0.6 Hz vs 1.2 Hz SD).
Conclusions: The present results confirm the strong individual reli-
ability of fast spindles also during daytime naps. This ‘trait’ feature
was not observed for slow spindle, which showed higher inter-­and
intra-­
subject variability and higher peak frequency compared to
nocturnal sleep spindles.
Disclosure: This work is supported by the University of Padova
under the STARS Grants program to N.C. The present work was
carried out within the scope of the research program ‘Dipartimenti
di Eccellenza’, which is supported by a grant from MIUR to the
Department of General Psychology, University of Padua.
P292 | Self-­reported sleep duration, sleep
quality and sleep problems in Mexicans adults:
Results of the Mexican National Halfway Health
and Nutrition Survey 2016
A. Arrona-Palacios1; M. Gradisar2
1
Writing Lab, TecLabs, Tecnologico de Monterrey, Monterrey, Mexico;
2
Flinders University, Adelaide, SA, Australia
Objectives/Introduction: This study aimed to investigate self-­
reported sleep duration, sleep quality and sleep problems in a
Mexican adult population by considering age, sex, geographical re-
gions and urban/rural residency.
Methods: A sample of 8649 Mexican adults (5689 females; mean
age 46.0 ± 16.9 years) completed a cross-­sectional national survey
called the Mexican National Halfway Health and Nutrition Survey
2016.
Results: Overall, mean sleep duration was 7:28 h, from which 37.3%
had sleep problems, and 52% reported good to very good sleep qual-
ity. Furthermore, middle-­aged adults slept less than younger and
older adults (p < 0.001), males slept less than females (p < 0.001),
urban residents slept less than rural residents (p < 0.001) and those
from the center region of the country slept less than from the north-
ern and southern regions (p < 0.001). Mainly, the Aguascalientes
state was the only state with a sleep duration below 7 h (6:45 h);
in contrast, the Durango state was the only state at the other ex-
treme (7:59 h). The results showed that at their 20s, Mexicans slept
8 h, after which decreased during their 30s. Then at their 50s par-
ticipants started sleeping more and even more at theirs 80s. Overall
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Mexicans who obtained sufficient sleep (≥7 hours) were more likely
to be female, in their 20s, reporting perceived ‘regular’, ‘good’ or
‘very good’ sleep quality, possessed no self-­reported sleep problems,
not smokers and resided in rural areas.
Conclusions: The present study's findings have important implica-
tions for understanding the nationwide features of sleep in Mexican
adults. Whilst the national average sleep duration was at the lower
end recommended by the National Sleep Foundation (7:28 h), more
than a third of those sampled reported difficulty sleeping. This sug-
gests that sleep hygiene, awareness and education is needed in the
Mexican society. This may be more so needed in central regions of
Mexico, where there is a greater urbanization, and potentially poorer
sleep hygiene environments and behaviors.
Disclosure: Authors thanks the Writing Lab from Tecnologico de
Monterrey for their technical and financial support. Authors declare
no conflict of interest.
P293 | The recovery of the processing of global
irregularity during forced awakening from slow-­
wave sleep
K. Liaukovich; Y. Ukraintseva
Human Higher Nervous Activity Lab, Institute of Higher Nervous
Activity and Neurophysiology of the Russian Academy of Sciences,
Moscow, Russian Federation
Objectives/Introduction: The transition from slow-­
wave sleep
(SWS) to wakefulness does not occur immediately. To describe the
changes in conscious processing during awakening from SWS, we
used global irregularity (GI), response to which is registered when a
participant is aware of a violation.
Methods: 1 female and 1 male (23 y.o.) without neurological and
sleep disorders participated in 5 and 6 experiments, respectively.
Before sleep we recorded event-­related potentials (ERPs) in response
to GI, which consisted of trials where the first four sounds were the
same (standards), but the fifth sound differed: 80% trials ended with
the deviant sound (515, 1,030, and 1,545 Hz) -­global standards (GS)
-­and 20% with the standard sound (485, 970, and 1,455 Hz) -­global
deviants (GD). When the participant reached SWS, GI was turned
on. The participant´s task was to wake up and press the button when
GD appeared. In total, there were 51 awakenings (4–6 per night).
We analyzed data in BrainVision Analyzer2.0 and conducted cluster-­
based permutation statistics for global effect (GD minus GS) after
the onset of the fifth sound in FieldTrip, MatlabR2019a.
Results: Before sleep, frontal positivity (140–288 ms, p = 0.02)
was followed by centro-­parieto-­occipital negativity (228–696 ms,
p = 0.002). Each awakening from SWS was divided into three con-
secutive steps: Step 1, the first 5–7 seconds, delta rhythm super-
imposed on alpha rhythm; Step 2 -­alpha rhythm appeared but no
motor response (MR) or it's slow; Step 3 -­alpha rhythm and MR are
comparable to those in waking state before sleep. We haven´t found
 |
214 of 356       ABSTRACTS
statistically significant results for Step 1 and Step 2. For Step 3, fron-
tal positivity (152–232 ms, p = 0.02) was followed by centro-­occipital
negativity (268–696 ms, p = 0.002). Comparing ERPs before sleep to
Step 3, fronto-­parietal negativity was more prominent for GS before
sleep only (120–696 ms, p = 0.02).
Conclusions: To sum up, after awakening from SWS not only alpha
rhythm but also MR restoration is needed for GI to elicit P3a -­an
index of automatic processing of changes in sound characteristics
-­and later cognitive component N400 -­an index of processing of
meaningful information and reaction towards the appearance of
noncongruent stimuli.
Disclosure: This study was supported by the RFBR grant (No
19-­313-­90067).
P294 | Smartphone use at bedtime: the
influence of sleep-­smartphone hygiene, trait
anxiety, and fear of missing out (FOMO) on sleep
quality
D. Hadar-Shoval1; O. Tzischinsky2
1
Psychology, 2Behavioral Science, Emek Yezreel College, Emek Yezreel,
Israel
Objectives/Introduction: Trait anxiety and Fear of Missing Out
(FOMO) are psychological factors that may be important in under-
standing the mechanisms behind the association between smart-
phone use in the sleeping environment (sleep smartphone hygiene
-­SSH) and sleep quality, as measured by sleep disturbance, sleep
onset latency and daytime dysfunction.
Aim: To examine the association between smartphone usage hab-
its in the sleep smartphone hygiene (SSH) and sleep quality among
students and to examine whether this association can be explained
through Trait Anxiety and/or FOMO as a moderate factors.
Methods: Participants: Israeli college students (N = 467) (316 women,
141 men; Mage = 25 ± 2.69 yrs).
Tools: Six questionnaires: SSHQ, Trait Anxiety Inventory (STAI-­T ),
FoMOs, Pittsburgh Sleep Quality Index (PSQI) and demographic
questionnaires.
Results: Significant regression model was found (F(4, 456) = 29.59,
p < 0.001) indicating that PSQI can be predicted by trait anxiety,
FOMO and sleep-­smartphone hygiene. The three variables explained
20% of the variance in PSQI. Trait anxiety offered the highest unique
contribution (β = 0.45, p < 0.001), followed by sleep-­smartphone hy-
giene (SSHQ; β = 0.12, p < 0.005). The contribution of FOMO was
not significant.
The moderation model was significant (F(5, 455) = 24.92, p < 0.001).
Trait anxiety was a statistically significant moderator of the relation-
ship between SSH and sleep quality (F(1, 455) = 5.24, p < 0.02) and
the interaction between SSH and trait anxiety explained 0.9% of the
variance in sleep quality. At low levels of trait anxiety (−1 SD) the
relationship between sleep and SSH was positive but insignificant.
At median and high levels of trait anxiety the relationship between
sleep and SSH were positive and significant. There was no statisti-
cally significant effect of FOMO on sleep.
Conclusions: Most of the students reported sleeping with their
smartphones and scrolling through it before bedtime. These findings
are important for coping with impairment of sleep quality. Advising
behavioral change is insufficient. Recommendations should also ad-
dress intra-­personal aspects, such as anxiety.
Disclosure: Nothing to disclose.
P295 | Adolescents’ smartphone usages in the
sleeping environment: parents´ attitudes and
involvement
A. Dor1; O. Tzischinsky2
1
Education; 2Behavioral Sciences, Max Stern Academic College of Emek
Yezreel, Emek Yezreel, Israel
Objectives/Introduction: The association between smartphones
use in the sleeping environment and impaired sleep quality has been
scientifically proven. The purpose of the current study is to examine
parents´ involvement in and awareness of their adolescent´s sleep-
ing hygiene, and the use of smartphones in the context of adopting
healthy sleep Hygiene.
Research goals: Examine the relationships between four variables:
A. Parents´ attitudes towards the importance of sleep; B. Parents´
assessments of their child´s smartphone usage; C. Parents´ assess-
ments of their child´s sleep patterns; D. Parents´ assessments of
their own involvement in the child´s sleep hygiene.
Methods: Subjects: 242 parents of adolescents (age 12–16). 53.7%
mothers.
Tools: A 15-­item demographic questionnaire; a 33-­item Likert-­scale
(1–5)questionnaire four measures: Parental attitudes towards the
importance of sleep (α = 0.73); Parent assessment of the child´s
smartphone usage (α = 0.66); Parents´ assessments of their child´s
sleep patterns (α = 0.79); Parents´ assessments of their own involve-
ment in the child´s sleep patterns (α = 0.68).
Procedure: Parents of adolescents age 12–16 were contacted
through Facebook and Whatsapp groups. Those who agreed to
participate were sent a link to Google forms. The participants com-
pleted an online anonymous questionnaire. The study was approved
by the Ethics Committee of YVC.
Results: Significant positive correlations were found between the
degree of parents´ involvement and the variables of sleep impor-
tance (r = 0.17, p < 0.01), child sleep patterns (r = 0.49, p < 0.001),
and pattern ´of smartphone usage (r = 0.46, p < 0.001 ). A significant
positive correlation was found between sleep and wake patterns and
smartphone usage pattern (r = 0.5, p < 0.001). The degree of involve-
ment maybe mediated significantly between sleep importance and
smartphone usage patterns.
ABSTRACTS
Conclusions: Explaining to parents about the importance of sleep
and reducing the smartphone usage in the sleeping environment is
associated with increasing parents awareness of this issue. Parents
are likely to increase their involvement in the smartphone usage pat-
terns in the sleeping environment, and to improve their children´s
sleep hygiene.
Disclosure: Nothing to disclose.
P296 | The impact of one-­night Total Sleep
Deprivation on the effects of pavlovian cues on
instrumental responses for food rewards
W.S. Chan
Psychology, University of Hong Kong, Hong Kong, Hong Kong
Objectives/Introduction: Inadequate sleep is a risk factor for obe-
sity. Prior studies suggest that inadequate sleep may influence
eating behavior. The present study aimed to evaluate if one-­night
experimentally-­induced total sleep deprivation (TSD) impacts the
effects of Pavlovian cues on the instrumental responses for food re-
wards using the Pavlovian-­Instrument Transfer (PIT) paradigm.
Methods: A within-­
individual randomized crossover design was
used. Forty-­six were randomized to undergo either TSD or the nor-
mal sleep control (NSC) condition first, followed by a 3-­day washout
period and the other condition. In the PIT training phase, partici-
pants acquired the associations between pressing two keys on the
keyboard (M and N) and two respective food rewards
(i.e., instrumental conditioning). Then, in the Pavlovian conditioning
phase, they were presented with neutral graphical pattern cues pair-
ing with the two food rewards used in instrumental conditioning and
two other food rewards, in addition to a control graphical pattern
cue pairing with ‘nothing’ as a control. In the PIT testing phase, they
are told to press either M or N as many times as they can to get the
food they want, in the presence and in the absence of the Pavlovian
cues. Participants completed the PIT training phases between 20:00
and 22:00 prior to sleep manipulation and the PIT testing phases
between 0800:10:00 in the following day for both conditions to con-
trol for circadian influences.
Results: Repeated-­measure ANOVA revealed a sleep × cue interac-
tion effect (F  =  3.38, df  =  2, p = 0.04, partial n2  = 0.08). This ef-
fect indicated that, following NSC, participant showed increased
instrumental responses for the cued food reward (specific transfer
effect). Following TSD, participants showed increased instrumental
responses for both the cued food reward and the non-­cued food
reward (general transfer effect).
Conclusions: The present finding is novel and suggests that sleep
deprivation may augment one's motivation to consume a particular
food item even when in the presence of cues associated with other
foods.
Disclosure: Nothing to disclose.
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P297 | Measures of sleep pressure in the wake
EEG under standard versus soporific conditions
following sleep deprivation
S. Snipes1,2; E. Meier1; R. Huber1,3
1
Child Development Centre, University Children's Hospital Zurich;
2
Neural Control of Movement Lab, Department of Health Sciences
and Technology, ETH Zürich; 3Department of Child and Adolescent
Psychiatry and Psychotherapy, Psychiatric Hospital, University of
Zurich, Zurich, Switzerland
Objectives/Introduction: Sleep pressure is often defined by changes
in slow wave activity during sleep, however various approaches can
be used to quantify sleep pressure during wake. The most com-
mon are subjective sleepiness ratings, performance on vigilance
tests, and, to a lesser extent, theta power (4–8 Hz) recorded with
the electroencephalogram (EEG). We aimed to directly compare
the sensitivity of these measures to changes in sleep pressure and
their robustness against external factors, specifically experimental
conditions.
Methods: 7 participants (age: 20–25y) performed a 12-­minute visuo-­
spatial reaction time task, first in a ‘classic’ condition (on a laptop,
seated at a desk, with normal lighting), then in a ‘soporific’ condition
(with a projector, seated in an armchair, raised legs, dim lights). Both
tasks were performed at 3 time points: 2 hours after a normal night
of sleep, 6 hours after 4 h sleep, and 20 hours after the 4 h sleep
period. We measured reaction times (RTs), theta power recorded
during the task, and subjective sleepiness (Karolinska Sleepiness
Scale, KSS) after the task. 2-­way repeated measures ANOVAs and
eta-­squared were used to evaluate effect sizes for each measure.
Z-­scored averages were used to account for large inter-­individual
differences.
Results: Theta power was significantly affected by time awake (η2 =
0.39, p = 0.0051) and not condition (η2 = 0.011, p = 0.48). RTs were
affected significantly by time awake (η2 = 0.14, p = 0.0040) as well as
condition (η2 = 0.67, p < e-6). KSS was affected significantly by time
awake (η2 = 0.22, p = 0.039), and trending in condition (η2 = 0.11,
p = 0.076).
Conclusions: Our preliminary analysis shows that theta power, hav-
ing the largest effect size for time awake, was the most sensitive
to changes in sleep pressure. Furthermore, because theta power
was not affected by experimental conditions, it can be considered
more robust to external manipulations than other measures of sleep
pressure. Subjective sleepiness and behavioural performance, while
significantly affected by sleep pressure, were also vulnerable to
changes in experimental conditions.
Disclosure: Nothing to disclose.
 |
216 of 356       ABSTRACTS
P298 |  ‘Help me make it through the night’ -­an
actigraphy study of sleep in early parenthood
H. Oginska; B. Stec
Jagiellonian University, Kraków, Poland
Objectives/Introduction: Although the birth of a child is one of the
happiest events in family life, in many cases (circa 15%) it is followed
by depressive states in new mothers (and, with not known preva-
lence, in new fathers). Moreover, the literature claims that most of
the couples experience the crisis in their relationship during the first
year of life of their child. Four main sources of problems are consid-
ered: postpartum depression, diminished sexual satisfaction, injus-
tice about the division of household tasks, and sleep deprivation.
Methods: Here we explored the sleep-­
wake patterns of moth-
ers and fathers with one-­
week wrist actigraphy registrations
th
(MotionWatch8, CamNtech Ltd) obtained between the 6 and 10
week of baby's life, and compared to a week from the second tri-
mester of pregnancy. So far, 16 couples took part in the study; mean
age of participants was 28.8 ± 3.7 years. Sleep analysis comprised
bed-­times, wake-­up times, time-­in-­bed, actual sleep and wake times,
sleep latency and efficiency. The circadian rhythm features were
estimated with non-­parametric-­circadian-­rhythm-­analysis (NPCRA
module) and comprised data on average activity levels for the se-
quences of 5 least and 10 most active hours, their relative ampli-
tude, intra-­daily variability (index of fragmentation of activity-­rest
periods) and interdaily stability (regularity) of activity-­rest pattern.
Results: Before the childbirth women showed a bit longer sleep
(20 min; p < 0.05) and more stable circadian rhythm (p < 0.04) than
their counterparts. No other gender differences were observed.
After the child was born, the sleep of mothers changed substantially:
they spent more time in bed (9 h 01 min vs. 8 h 25 min; p < 0.03), but
their wake time during the night was longer by 39 min (p < 0.001).
Consequently -­their sleep efficiency dropped (p = 0.001) and sleep
fragmentation upsurged (p < 0.001). Their activity in ‘least active
hours’ has doubled. The sleep of fathers did not change significantly.
The most spectacular effect -­fragmentation of sleep -­was visible
only in mothers (increased index from 29.4 to 40.5), while in fathers
it remained on the same level (29.6 -­30.6).
Conclusions: Those results may reflect the ‘traditional’ division of
family responsibilities in young parents, i.e. mother's alertness for
baby's ‘night calls’.
Disclosure: Nothing to disclose.
P299 | Fractal regulation of human motor
activity and its manifestation at circadian and
ultradian time scales
G. Hammad1; M. Reyt1,2; M. Baillet1; M. Deantoni1; S.
Laloux1; E. Lambot1; A. Lesoinne1; V. Muto1; C. Schmidt1,2
1
GIGA -­CRC In Vivo Imaging; 2Psychology and Neuroscience of
Cognition Research Unit, Faculty of Psychology and Educational
Sciences, Université de Liège, Liège, Belgium
Objectives/Introduction: Human activity exhibits a fractal behav-
iour, characterised by scale-­invariant patterns over time scales rang-
ing from minutes to 24 hours. This suggests the existence of a control
mechanism with feedback interactions. Aging and Alzheimer's dis-
ease, both marked by an alteration of the suprachiasmatic nucleus
(SCN), the circadian pacemaker, have been associated with a reduced
th
scale-­invariant correlation. However, the impact of this reduction on
ultradian or circadian activity dynamics and its comparison with in-­
lab circadian measures, remains unclear.
Methods: Forty-­nine healthy elderly participants (69 ± 5.9 years,
43% female) underwent a 40-­h multiple nap constant routine (CR).
Activity was recorded using actimetry during 11 days. First, fractal
correlations, αultra and αcirca, calculated using detrended fluctuation
analysis over time ranges [0,200] min. and [200,1440] min. were
confronted to the relative circadian modulated-­
amplitude in be-
haviour, as measured by psychomotor vigilance task (PVT), every
4 h during the CR. Then, using actimetry, fractal correlations were
tested as predictors of activity fragmentations occurring at vari-
ous time scales: at circadian time scales, using the fraction of rest
time (fSoD) over a typical wakefulness afternoon period and at short
ultradian time-­scale (typically [10–20] min.) using daytime activity
(kAR) and night sleep (kRA) fragmentations, quantified with state-­
transition probabilities. The link between scale-­invariance and the
ultradian locomotor inactivity dynamics during sleep (LIDS, typical
time scale: 100 min.) were also investigated.
Results: Linear mixed effect regressions indicated that PVT rela-
tive circadian amplitude (b = −1.15, p = 0.012), daytime rest (fSoD,
b  =  −0.36, p  =  0.001) and activity fragmentation (kAR, b  =  −2.35,
p = 0.001) were associated with αcirca, as well as an association be-
tween LIDS amplitudes and αultra (b = −14,48, p = 0.050). A link be-
tween kAR and αultra was also observed (b = 1.35, p = 0.002).
Conclusions: Our results link fractal indices, measured with actigra-
phy, to in-­lab circadian markers. Interestingly, fractal scaling in the
circadian regime is associated with both daytime rest, interpreted as
a fragmentation of sustained daytime activity, and shorter ultradian
daytime activity fragmentation. These results also highlight the link
between LIDS oscillations at night and scale-­invariance at ultradian
time scales. Overall, our analysis suggests that previously reported
indices of activity dynamics occurring at various time scales might be
associated with a common underlying regulation mechanism, involv-
ing the SCN.
Disclosure: Nothing to disclose.
ABSTRACTS
P300 | Confirmatory factor analysis of
the anxiety upon awakening assessment
questionnaire
I. Saez-Uribarri
Onirotest, Bilbao, Spain
Objectives/Introduction: The Anxiety upon Awakening Assessment
Questionnaire (CEAD, as per the Spanish acronym) is an instrument ap-
plied after awakening or, at the latest, on the same day as awakening. The
original version consisted of 25 items (for example: upset, startled, nerv-
ous, tense body, etc.). The possible values of the items range from 1 to
5 so that the subject can rate the sensation on awakening from lesser to
greater. The aim of the study is to verify the factor validity of the CEAD.
Methods: The CEAD was distributed on the internet. A total of 523
responses were obtained. Those under the age of 16 years and those
who reported that they had answered the questionnaire more than
once were removed from the sample. It was also verified that there
were no repeat cases based on date of birth, place of birth and sex.
Finally, 487 cases were analysed. A confirmatory factor analysis was
conducted by performing an extraction using the maximum likeli-
hood method. Given that the data did not fit the multivariate normal
distribution, a non-­linear transformation was performed on the re-
sponses and a bootstrap algorithm with 2000 samples was applied.
Results: A model with a satisfactory fit was not obtained with the initial
questionnaire. However, the model did fit after removing six items (Chi-­
square with p < 0.001; CMIN/DF < 5; GFI and CFI > 0.90; RMSEA < 0.08).
The 19 remaining items continued to saturate in a single factor of anxi-
ety upon awakening. The existence of a group factor which explained
the additional relationships between three items and the existence of
relationships between the errors of some item pairs were observed. The
corresponding Cronbach's alpha obtained was 0.91.
Conclusions: A reduced version of the CEAD has sufficient factor
validity and reliability to assess the level of anxiety upon awaken-
ing. This variable may be very useful in laboratory dream research
or dream diary research. This is also true in clinical practice dealing
with bad dreams or nightmares, such as post-­traumatic stress disor-
der and nightmare disorder.
Disclosure: Nothing to disclose.
P301 | Prevalence of comorbidities in OSA
-­COPD overlap syndrome patients in a cohort
from Western Romania
S. Frent1; R. Pleava2; C. Serban3; C. Ardelean4; I. Marincu5; S.
Mihaicuta1
1
Pulmonology; 2University of Medicine and Pharmacy Timisoara;
3
Functional Sciences, University of Medicine and Pharmacy Timisoara;
4
Cardioprevent Foundation; 5Infectious Diseases, University of
Medicine and Pharmacy Timisoara, Timisoara, Romania
|
      217 of 356
Objectives/Introduction: Chronic obstructive pulmonary disease
(COPD) and obstructive sleep apnea (OSA) are each frequently as-
sociated with several comorbidities. The overlap syndrome (OVS) re-
fers to the presence of the 2 conditions in the same patient and may
be associated with a higher prevalence of comorbidities than each
individual disease. Our aim was to assess the prevalence of associ-
ated comorbidities in patients with OVS compared with OSA alone.
Methods: We performed a data analysis of consecutive patients re-
ferred to our Sleep lab from 2005 to 2018. Patients were divided in 2
groups: OVS and OSA alone. The diagnoses of OSA and COPD were
established according to standard diagnostic criteria. Clinical data
on the presence of several commonly associated chronic diseases
was systematically collected for all patients based on patients’ self-­
report of concomitant conditions and medication use and available
medical records. We then compared the data between the groups
using Chi-­square test. A p value < 0.05 was considered significant.
Results: 2173 patients were assessed, of whom 381 patients (17.5%)
had OVS and 1792 patients (82.5%) had OSA alone. We found sig-
nificant differences between the OVS and OSA group in the preva-
lence of the following conditions: hypertension (79.5% vs. 66.9%,
p < 0.001), coronary artery disease (49.2% vs. 28.9%, p < 0.001), ar-
rhythmias (30.8% vs. 22.7%, p < 0.001) and type 2 diabetes (38.1%
vs. 17.4%, p < 0.001). Although not statistically significant probably
due to small numbers, a numerically higher percentage of patients in
the OVS group had stroke (5.8% vs. 4.3%, p = 0.22).
Conclusions: Common comorbidities, especially cardiovascular, are
significantly more prevalent in patients with OSA -­COPD overlap
syndrome compared to OSA alone.
Disclosure: Nothing to disclose.
P302 | Prevalence and risk factors for
obstructive sleep apnea in truck drivers
Â. Dias Cunha1; V. Costa2; A.B. Loureiro2; M. Conceição1; S.
Guerra1; R. Ferro1; R. Nunes1; A. Simões Torres1
1
Pulmonology, Centro Hospitalar Tondela-­Viseu, E.P.E., Viseu; 2Linde
Saúde, Maia, Portugal
Objectives/Introduction: Obstructive sleep apnea (OSA) has been
reported to affect approximately 5% of the general population.
However, it appears to be much more common among professional
drivers, with an estimated prevalence of 17–28%. Several studies
have shown a clear association between OSA and increased risk of
traffic accidents. The aim of this study was to investigate the pres-
ence of risk factors and symptoms for OSA and its prevalence in a
truck drivers’ cohort.
Methods: We performed a prospective study that included 281 male
truck drivers of a transportation company. Demographic, anthropo-
metric and historical data, physical evaluation, Epworth Sleepiness
Scale (ESS), STOP-­Bang and Berlin Questionnaire (BQ) were used to
 |
218 of 356       ABSTRACTS
select subjects with suspicion of OSA. Ambulatory polysomnogra-
phy (level 3 PSG) was performed to confirm diagnosis.
Results: Mean age was 44.63 ± 7.30 years, mean body mass
index was 28.72 ± 4.05 kg/m2 and mean neck circumference was
41.13 ± 3.2 cm. Their past medical history included obesity (31.3%),
arterial hypertension (14.2%), dyslipidemia (9.6%) and diabetes mel-
litus (5%). 60.1% had smoking habits.
Of the 281 truck drivers screened, 72 (25.6%) reported habitual
snoring, 21 (7.5%) witnessed apneas, 31 (11%) reported daytime
sleepiness and 94 (33.5%) admitted feeling sleepy while driving.
However, only 3.9% presented excessive daytime sleepiness when
evaluated thought ESS (ESS ≥ 11). The prevalence of insomnia (in-
somnia severity index score ≥ 15) was 8.5%.
According to the BQ and STOP-­Bang questionnaires, 28.1% and
28.5% of patients were at high risk for having OSA, respectively.
Therefore, a total of 88 (31.3%) subjects were positive for potential
OSA. Of these, 63 completed PSG study and the diagnosis was con-
firmed in 54 (85.7%): 18 had mild, 24 moderate and 12 severe OSA.
This accounts for a prevalence of at least 19.2%. The following vari-
ables showed a positive correlation with AHI: neck circumference
(r = 0.42; p = 0.001) and STOP-­Bang (r = 0.37; p = 0.006).
Conclusions: Screening, treatment and management of OSA has not
only benefits for the driver itself but should be a priority as a pub-
lic safety policy. The use of questionnaires proved to be a valuable
and simple tool for OSA screening, and in our opinion, this screening
should be implemented as an occupational requirement for profes-
sional drivers.
Disclosure: Nothing to disclose.
P303 | Risk factors for non-­compliance with
continuous positive airway pressure in patients
with obstructive sleep apnea and paroxysmal
atrial fibrillation
G.M. Traaen1; M.K. Vik-Strandli1; B. Øverland2; L. Aakerøy3;
T.-E. Hunt1; N. Bredesen3; C. Bendz1; L.Ø. Sande1; S.
Aakhus3; S. Steinshamn3; O.-G. Anfinsen1; J.P. Loennechen3;
H. Akre1; L. Gullestad1
1
Oslo University Hospital; 2Lovisenberg Hospital, Oslo; 3St. Olavs
Hospital, Trondheim, Norway
Objectives/Introduction: Previous studies have shown an associa-
tion between obstructive sleep apnea (OSA) and atrial fibrillation
(AF). Continuous positive airway pressure (CPAP) is the first choice
of therapy for most patients with OSA. Despite the improvements in
CPAP technology and the high efficacy of the device in reducing hy-
poxemia, CPAP adherence is often sub-­optimal. Patients diagnosed
with OSA in cardiovascular clinics more often have difficulties with
CPAP adherence because they are minimally symptomatic. Aim of
this study was to find risk factors for CPAP non-­compliance in pa-
tients with AF.
Methods: We prospectively studied 154 patients with paroxysmal
AF and OSA (AHI  ≥  15/h), during CPAP-­tolerability test. Patients
were monitored remotely and in addition data was downloaded from
the device. Compliance was defined as device usage for > 4 hours
per night. The Epworth Sleepiness Scale (ESS) assessed the degree
of sleepiness. The Atrial Fibrillation Severity Scale (AFSS) assessed
the patients burden and symptoms of AF, and the Short Form-­36
(SF-­36) obtained the quality of life. Body composition data were col-
lected using a bioelectric impedance weight. Lung function (forced
vital capacity (FVC)) was measured by spirometry.
Results: The study included 33 women (21%) and 121 men (79%).
Mean age was 62.6 ± 7.2 years and mean body mass index (BMI)
was 29.4 ± 4.3 kg/m². The median AHI was 22.8 (17.6–32.3) (range
15.1–85.8) and was predominantly obstructive. Median usage of
the CPAP-­device was 13.0 (8–26) days. Of the cohort 115 (75%)
were CPAP compliant, while 39 (25%) were non-­compliant. Non-­
compliant patients had significantly higher alcohol consumption and
a higher FVC. Compliant patients surprisingly had higher leakage
from the CPAP mask. We found no association between CPAP com-
pliance and other comorbidities. Neither was there an association
between CPAP compliance and age, sex, BMI, body fat percentage,
neck-­and waist circumference, quality of life (SF-­36), AFSS symptom
score and ESS.
In multivariate analysis only a higher FVC and AFSS burden and a
lower AHI remained significant independent risk factors of non-­
compliance. A two-­sided p-­value < 0.05 was considered significant.
Conclusions: Our study has shown that independent risk factors of
non-­compliance were higher FVC and AFSS burden, while higher
AHI was associated with better compliance.
Disclosure: Gunn Marit Traaen has received speaker honoraria from
ResMed, Norway. The authors report no other relationships that
could be construed as a conflict of interest.
P304 | Sleep, obstructive sleep apnea
and cardiometabolic health in an aging rural
community in South Africa
J. Roche1; D. Rae2; K. Redman1; M. von Schantz3; F.X.
Gómez-Olivé 4; K. Scheuermaier1
1
Wits Sleep Lab, Brain Function Research Group, School of Physiology,
University of the Witwatersrand, Johannesburg; 2Division of Exercise
Science and Sports Medicine, Department of Human Biology,
University of Cape Town, Cape Town, South Africa; 3Faculty of Health
and Medical Sciences, University of Surrey, Surrey, United Kingdom;
4
MRC/Wits Rural Public Health and Health Transitions Research Unit
(Agincourt), School of Public Health, University of the Witwatersrand,
Johannesburg, South Africa
Objectives/Introduction: Short sleep duration and obstructive
sleep apnea (OSA) are known to increase cardiometabolic disor-
ders. Increased risk of OSA has been reported in African Americans;
ABSTRACTS
however, objective measures of sleep and OSA, and their associa-
tion with cardiometabolic risk (CMR) in people of African ancestry
living in Southern Africa are scarce. In this cross-­sectional study, we
compared the clinical, cardiometabolic and sleep parameters of par-
ticipants with and without OSA recruited from an aging, rural, low
socioeconomic status, South African population of African ancestry
and investigated parameters associating with increased CMR.
Methods: Eighty-­one participants (average age = 66.3 ± 10.5 years
(SD); 57 women) were sampled from the ongoing HAALSI health and
aging study in rural South Africa. A continuous CMR score instru-
ment (MetScoreWC) was calculated using waist circumference (WC),
non-­fasting glucose, systolic and diastolic blood pressures. Presence
of overweight/obesity (BMI ≥ 25 kg.m-2), diabetes, and hypertension
(HTA) was investigated. We investigated sleep and respiratory pa-
rameters using home-­based overnight polysomnography and manual
scoring. Measures included total sleep time (TST) and arousal index
(events/hour). Apnea-­hypopnea index (AHI) for detection of OSA
(AHI ≥ 15), and oxygen desaturation index ≥ 3% (ODI) were calcu-
lated. The association between MetScoreWC and age, sex, AHI and
TST was investigated by multivariable analysis.
Results: Respiratory parameters were missing from six partici-
pants. Twenty-­t wo participants out of 75 had OSA and were older
(p = 0.02), had a greater BMI (p = 0.02), WC (p < 0.01) and MetScoreWC
(p = 0.03) than those without OSA. Participants with and without
OSA had similar overweight/obesity, diabetes and HTA prevalence,
sex distribution, and TST of about 6.6 ± 1.0 h. Participants with OSA
had a greater ODI (p < 0.0001) and arousal index (p < 0.0001) than
subjects without OSA. Being a woman (ß = 0.381, p = 0.018) and
AHI severity (ß = 0.010, p = 0.037) were associated with a greater
MetScoreWC , while TST and age were non-­significant predictors.
Conclusions: Cardiometabolic disorders are leading causes of morbidity
and mortality in South Africa. In this study, we found an alarming preva-
lence of OSA, of about 29.3%. Having OSA was associated with an in-
creased CMR. These findings suggest that a more systematic prevention,
detection, and treatment of OSA in the Southern African healthcare pub-
lic sector would help prevent cardiometabolic disorders in South Africa.
Disclosure: Newton Advanced Fellowship from Academy of
Medical Sciences (to FXGO and MvS) -­Postdoctoral fellowship from
University of the Witwatersrand's University Research Council to
JR -­HAALSI National Institute on Aging (P01AG041710) funding to
FXGO.
P305 | Epworth Sleepiness Scale and STOP-­
Bang questionnaire as screening tools for
obstructive sleep apnea
C. Pimentel; C. Santos; S. Feijó
Pulmonology, Centro Hospitalar de Leiria, Leiria, Portugal
Objectives/Introduction: Despite being the most prevalent sleep-­
breathing disturbance, Obstructive Sleep Apnea (OSA) is still an
|
      219 of 356
underdiagnosed disease. Therefore, the development of non-­
invasive screening tools for this disorder is of extreme importance.
Two of the better recognized tools are the Epworth Sleepiness Scale
(ESS), which assesses the propensity to dozing and the severity of
daytime sleepiness based on eight self-­administered questions, and
STOP-­Bang questionnaire, which consists of eight questions that
evaluate four clinical variables and four anthropometric variables
and stratifies patients according to the risk of OSA.
Objective: This study aimed to compare the accuracy of ESS and
STOP-­Bang questionnaire to predict the Apnea Hypopnea Index
(AHI).
Methods: A single-­
center retrospective observational study was
carried out in our hospital. All consecutive patients followed in the
pulmonology consultation who underwent a level 3 polysomnogra-
phy in the last semester of 2019 were included. Demographic and
clinical data from these patients were collected. Patients previously
diagnosed with OSA or without all necessary clinical information
were excluded. Spearman test was performed to analyse the cor-
relation between AHI and the severity of daytime sleepiness using
the ESS. Kruskal-Wallis test was performed to correlate AHI and the
risk of OSA calculated by the STOP-­Bang questionnaire. IBM SPPS
Statistics version 26 was used to analyze all the data and a p value
less than 0,05 was considered statistically significant.
Results: 222 patients (72% male) were included in this study, with
a median age of 58,07 years (95% IC 56,45–59,68). No correlation
was found between AIH and the score on ESS (p = 0,533, rs=−0,042).
Regarding STOP-­Bang risk groups, the median AIH of the low risk
group was 2,0/h, for the intermediate risk group the median AHI was
10,95/h and for the high risk group was 22,9/h. No significant statis-
tical differences were observed between low risk and intermediate
risk groups (p = 1,000). Nevertheless, we found significant statistical
differences between the medians AHI of high risk and intermediate
risk groups (p < 0,05).
Conclusions: In our sample, STOP-­Bang questionnaire proved to be
a better screening tool to predict the risk of OSA than ESS.
Disclosure: Nothing to disclose.
P306 | Peripheral biomarkers of obstructive
sleep apnea in Alzheimer's disease patients
G. Piñol1; A. Targa2; I. Benitez2; F. Dakterzada1; F. Barbe3
1
Unitat Trastorns Cognitius, Clinical Neuroscience Research, Santa
Maria University Hospital, IRBLleida; 2Translational Research in
Respiratory Medicine, Hospital Universitari Arnau de Vilanova-­Santa
Maria, IRBLleida, Lleida; 3Translational Research in Respiratory
Medicine, Hospital Universitari Arnau de Vilanova-­Santa Maria,
IRBLleida, Lleida, Spain
Objectives/Introduction: To investigate the potential of microRNAs
(miRNAs) as biomarkers for the diagnosis of obstructive sleep apnea
(OSA) in Alzheimer's disease patients
 |
220 of 356       ABSTRACTS
Methods: In this prospective, single-­center study (NCT02814045),
patients were diagnosed with Alzheimer's disease according to the
National Institute on Aging -­Alzheimer's Association (NIA-­A A) rec-
ommendations. In addition, OSA was defined as an apnea-­hypopnea
index (AHI) > 15 events/h according to overnight polysomnography
(PSG). Blood samples were collected at the following morning, and
then a RT-­qPCR Taqman Low-­Density Arrays of 768 miRNAs was
performed.
Results: The cohort included 29 patients, from which 12 patients
were diagnosed as non-­OSA (41.38%) and 17 as OSA (58.62%). The
median (SD) age of the individuals was 75.8 (5.99) years and the ma-
jority was composed of women (96.6%).
We observed a set of 9 miRNAs that provided a discriminatory model
of the OSA risk profile. From these, 7 miRNAs were significantly cor-
related with the AHI, suggesting a role not only as biomarkers for the
presence of OSA but also for its severity.
Conclusions: Our preliminary results suggest that there are a set
of miRNAs that could be important biomarkers for the diagnosis of
OSA in Alzheimer's disease patients and for the evaluation of OSA
severity in those patients. These results should be further confirmed
in a validation cohort.
Disclosure: Nothing to disclose.
P307 | Actigraphic analysis of sleep
and circadian disturbance in premanifest
Huntington's disease: sleep period activity
increases progressively and predicts motor
outcome
T. Lopez1; Z. Voysey1; A.O. Goodman1; L. Rogers2; A.S.
Lazar3; R.A. Barker1
1
Department of Clinical Neurosciences, University of Cambridge;
2
Sleep Centre, Royal Papworth Hospital Foundation Trust, Cambridge;
3
School of Health Sciences, University of East Anglia, Norwich, United
Kingdom
Objectives/Introduction: Sleep and circadian abnormalities precede
and form a significant aspect of many neurodegenerative conditions,
and are a focus of current research due to their potential contribu-
tion to symptomatology and/or disease progression. Huntington's
disease (HD), a monogenic fully penetrant neurodegenerative condi-
tion, provides a rare opportunity to study such sleep abnormalities
longitudinally prior to clinical manifestation of disease. The study of
rest/activity patterns via wrist-­worn movement sensitive devices
(actigraphy) facilitates prolonged, domiciliary study of sleep param-
eters. Here, we present the first longitudinal study of actigraphy in a
premanifest HD gene carrier cohort.
Methods: 18 premanifest HD gene carrier individuals (mean age
44.6 ± 11.5 years; 8 male) and 13 controls (mean age 52.5 ± 14.2 years;
6 male) underwent 2 two-­week periods of actigraphy at an interval
of 20 months. Mean disease burden score (DBS), a measure of prox-
imity to disease onset, was 214 ± 67 points among gene carriers.
We derived measures of onset time and activity levels during the
daily least active 5 hours (L5) and most active 10 hours (M10), plus
sleep fragmentation index, interdaily stability (IS) and intradaily vari-
ability (IV). Multivariate models were used to estimate the main ef-
fects of group, time and their interactions controlled for age, gender
and DBS. 10 premanifest subjects were reviewed clinically after
prolonged interval (mean 11 years, range 9–12 years) via Unified
Huntington's Disease Rating Scale (UHDRS).
Results: Premanifest HD individuals demonstrated a significant de-
crease in relative rest-­activity amplitude (F = 6.86, p = 0.014) driven
by a significant increase in L5 activity (F = 9.40, p = 0.005). The effect
was independent of age, gender and DBS. This was accompanied by
a significant increase in fragmentation index (F = 9.90, p = 0.004),
which was independent of age and DBS but weighted toward male
subjects (F = 4.97, p = 0.035). No effect for IS/IV was demonstrated.
Linear regression analyses revealed that higher baseline L5 activity
predicted a worse UHDRS motor score (R 2 = 0.41, p = 0.037).
Conclusions: Our results support those of cross-­
sectional acti-
graphic and polysomnographic studies suggesting that sleep periods
are fragmented and progressively disturbed by activity in individuals
carrying the HD gene, several years prior to clinical manifestation
of the disease. Our study is the first to corroborate such findings
longitudinally and to suggest that such activity may bear prognostic
value.
Disclosure: Nothing to disclose.
P308 | Morphological measures of sleep
spindles as a biomarker of Parkinson´s disease
L.M. Nilsson1; H. Leonthin2; M. Nikolic2; P.J. Jennum2; J.A.E.
Christensen1,2
1
Department of Health Technology, Technical University of Denmark,
Kongens Lyngby; 2Danish Center for Sleep Medicine, Department of
Clinical Neurophysiology, Rigshospitalet, Glostrup, Denmark
Objectives/Introduction: Sleep spindles (SS) have been shown to be
altered in patients with Parkinson´s disease (PD) [1]. In this study,
morphological SS characteristics were investigated as possible PD
biomarkers. A SS detector was implemented, and used on sleep EEG
signals. Three known morphological measures were computed for
each SS: the duration, oscillation frequency (OF) and maximum peak-­
to-­peak amplitude (Ap2p), along with four new measures: the mean
of the upper envelope (mUE), the mean of the lower envelope (mLE),
the range of the envelope (RE) and the inter-­peak-­variability (IPV).
Methods: A total of 15 patients with PD (7 males, 62.7 ± 5.8 years)
and 15 control subjects (7 males, 62.9 ± 5.9 years) were included.
Five experts manually scored SS in 8 blocks of 5-­minutes noise-­free
N2 sleep, and a gold standard was defined by a group consensus
[1]. The SS detector was inspired by Ferarelli et al. [2], optimized by
ABSTRACTS
integrating the band-­pass filtered signal in 0.5s windows and trained
on 12/15 control subjects to find an optimal threshold. SS longer
than 3s were removed. The detector was tested on 3/15 control
subjects and 15 PD patients. The detector was applied on the full-­
night EEG, and the duration, OF, Ap2p, mUE, mLE, RE and IPV were
calculated for each SS found by the detector in all N1, N2, N3 and
REM sleep stages between lights off and on. Inter-­group compari-
sons were performed using Wilcoxon Rank sum tests.
Results: The SS detector yielded a test F1-­score (µ±σ across sub-
jects) of 0.30 ± 0.04 for control and 0.37 ± 0.21 for PD. Significant
differences between the PD group and control group were found
for several morphological measures: OF (PD < control, p = 0.028),
Ap2p (PD > control, p = 0.004), mUE (PD > control, p = 0.042), mLE
(PD < control, p = 0.047), RE (PD > control, p = 0.018) and IPV (PD >
control, p < 0.001).
Conclusions: Several of the investigated morphological character-
istics were found to differ between PD patients and controls, and
constitute potential disease biomarkers. Longitudinal studies also
including pre-­PD patients are necessary to fully evaluate the bio-
marker potential of the morphological SS measures.
References:
[1] Christensen et al, Front Hum Neurosci 2015;9:233.
[2] Ferarelli et al, Am J Phychiatry 2007;164:483-­92.
Disclosure: Nothing to disclose.
P309 | The potential of bright light treatment
in the management of depression and anxiety in
dementia during winter
E. Kolberg1; S. Pallesen2; G. Johnsen Hjetland1; I.H.
Nordhus1; E. Thun1; E. Flo-Groeneboom1
1
Department of Clinical Psychology; 2Department of Psychosocial
Science, University of Bergen, Faculty of Psychology, Bergen, Norway
Objectives/Introduction: Behavioral and psychological symptoms
of dementia (BPSD), including symptoms of depression, agitation,
anxiety and disrupted sleep, affect the vast majority of people with
dementia. BPSD may be elicited and/or aggravated by circadian
disturbances. Bright light treatment (BLT) has been identified as a
promising non-­pharmacological option in the management of BPSD,
but results have so far been mixed and trials of longer duration have
been called for.
Methods: The Cornell Scale for Depression in Dementia (CSDD) and
the Neuropsychiatric Inventory Nursing Home Version (NPI-­
NH)
were used to assess BPSD. Eight nursing home dementia units
(N = 69) participated in a cluster randomized control trial from
September 2017 to April 2018. Four dementia units in the inter-
vention group had a ceiling mounted LED-­solution installed in the
living room, providing illuminance of 1000 lux, 6000K at eye level
between 10am and 3 pm, with lower illuminances and color tem-
peratures during mornings and evenings. The control group received
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standard indoor lighting. Data were collected at baseline and after 8,
16 and 24 weeks. Analyses were performed using multilevel regres-
sion modelling with time since baseline and condition as predictors,
baseline values and dementia stage as covariates, and random inter-
cepts for patients. Analyses were performed with and without false
discovery rate (FDR) correction.
Results: Affective symptoms were improved in the intervention
group compared to the control group at week 16 follow-­up, at which
time the intervention group had a larger reduction than the control
group on the composite scores on both the CSDD (p = 0.029) and the
NPI-­NH (p = 0.031). With FDR correction, the group difference was
significant on the CSDD Mood subscale (p = 0.001) and the NPI-­NH
Affect sub-­syndrome (p = 0.047) only. No differences were found
between conditions at week 8 or 24.
Conclusions: BLT has the potential to be an effective tool in the man-
agement of affective symptoms in people with dementia, without
side-­effects associated with many pharmacological interventions.
Disclosure: Nothing to disclose.
P310 | Unfavourable cardiovascular profile is
associated with sleep-­wake disturbances and
predicts future cardio-­cerebrovascular events in
stroke patients
I. Filchenko; M. Dekkers; M. Schmidt; C. Bernasconi; C.
Bassetti
Department of Neurology, University Hospital, Inselspital, Bern,
Switzerland
Objectives/Introduction: The association between sleep-­wake dis-
turbances (SWD) and cardio-­cerebrovascular risk is a matter of active
research, and little is known about the pathophysiological mecha-
nisms of this interaction. We hypothesised that SWD could be associ-
ated with endothelial dysfunction, arterial stiffening and decreased
heart rate variability (HRV) that, consequently, would increase cardio-­
cerebrovascular risk and adversely affect stroke outcome.
Methods: This project is a part of the Sleep Deficiency & Stroke
Outcome Study. We prospectively evaluated sleep characteristics
(questionnaires, respirography, actigraphy) and EndoPAT-­
derived
cardiovascular parameters (endothelial function, arterial stiffness,
HRV) in 49 stroke patients at admission. We assessed neurologi-
cal outcome at discharge and at 12 months post-­stroke. Cardio-­
cerebrovascular events (CCVE) were recorded during a 2-­
year
post-­stroke follow-­up.
We used linear or logistic regression with adjustment for age and
gender to investigate the association between cardiovascular and
sleep characteristics and to predict future CCVE and neurologi-
cal outcome with cardiovascular parameters. Finally, we defined a
Vascular Burden Index (VBI) as the sum of z-­scores of the follow-
ing representative EndoPAT-­
derived cardiovascular parameters,
selected based on expert opinion: reactive hyperaemia index (RHI),
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222 of 356       ABSTRACTS
augmentation index (AI), root mean square of the successive differ-
ences (RMSSD), low frequency (LF), LF to high frequency (HF) ratio
(LF/HF). We evaluated the predictive value of VBI for future CCVEs
as well as for early and late neurological outcome.
Results: SWD were generally associated with EndoPAT-­derived cardio-
vascular parameters that carry a negative cardiovascular prognosis. We
observed the following significant associations: Epworth Sleepiness
Scale vs. HF (β=0.314; p = 0.046) and RMSSD (β=0.371; p = 0.017);
insomnia severity index vs. RHI (ISI ≥ 8; β=−0.325; p = 0.035); apnea-­
hypopnoea index (AHI) vs. RHI (AHI ≥ 5/h; β=−0.414; p = 0.021); rest-
less leg syndrome vs. LF (β=0.323; p = 0.032) and LF/HF (β=0.307;
p = 0.045).
The VBI had the following standard deviation and range: 1.7087
[−4.550–4.040], with higher values reflecting worse cardiovascular
profile. VBI showed a trend for the association with Pittsburgh sleep
quality index (β=0.325; p = 0.051).
VBI, but not the individual cardiovascular parameters, predicted fu-
ture CCVE (OR  =  1.763; 95%CI [1.069; 2.906]; p = 0.026). Neither
individual cardiovascular parameters nor VBI predicted neurological
outcome.
Conclusions: These findings point to an association of EndoPAT-­
derived cardiovascular parameters with sleep characteristics and
with cardio-­cerebrovascular risk in stroke patients.
Disclosure: Nothing to disclose.
P311 | The bidirectional relations between
sleep and psychosocial difficulties from age 12 to
18 in Finnish adolescents
L. Kortesoja1; M.-P. Vainikainen2; R. Hotulainen1; A.
Rimpelä3; H. Dobewall3; P. Lindfors3; S. Karvonen4; I.
Merikanto5
1
Centre for Educational Assessment, Faculty of Educational Sciences,
University of Helsinki, Helsinki; 2Faculty of Education and Culture;
3
Faculty of Social Sciences, Unit of Health Sciences,, Tampere
University, Tampere; 4Social Policy Research Unit, Finnish Institute
for Health and Welfare; 5SleepWell Research Program, Faculty of
Medicine, University of Helsinki, Helsinki, Finland
Objectives/Introduction: The association of adolescents’ short sleep
and sleep problems with mental health is well established in cross-­
sectional studies (Becker et al. 2015; Tu et al. 2015). However, the
longitudinal effects of sleep on adolescent psychosocial well-­being
are mostly unknown. In addition, previous studies show that ado-
lescent's circadian preference for eveningness is related to impaired
daytime functioning (Wolfson and Carskadon 1998) and increased
internalizing problems (Quach et al. 2018) that could be explained
by lack of sleep and impaired sleep quality (Merikanto et al. 2017).
Using cross-­lagged structural equation models, this study examined
for the first time how adolescents’ sleep duration and sleep prob-
lems were associated with later psychosocial difficulties and vice
versa from early to late adolescence. In addition, the present study
investigated the relations between adolescent sleep duration, sleep
problems and psychosocial difficulties.
Methods: The data consisted of Finnish adolescents who were fol-
lowed five years with three time points (Time 1: n = 8834; Mean
age = 13 years, 51.1% female, Time 2: n = 5315, Mean age = 15 years,
51.6% female, Time 3: n = 3712; Mean age = 17 years; 50.2% fe-
male). The Strengths and Difficulties Questionnaire (SDQ) was used
for measuring psychosocial difficulties. The SDQ is suitable for
measuring both internalizing and externalizing behaviors (Goodman
et al. 2010). Adolescent sleep duration was calculated by counting
the hours between self-­reported bedtime and wake-­up time. Sleep
problems were assessed with a single question concerning general
sleep problems.
Results: The findings of this study showed that short sleep duration
was a stronger predictor of psychosocial difficulties than vice versa
throughout adolescence. Controversially, increased psychosocial
difficulties predicted sleep problems more strongly than reverse.
To summarize, the results showed that short sleep duration predis-
posed to psychosocial difficulties across adolescence, which led to
increased prospective sleep problems.
Conclusions: The findings of this study show a developmental pro-
cess where sleep and psychosocial difficulties have a bidirectional
and complex relationship in shaping adolescents’ health. Published
article: https://doi.org/10.1007/s10964-020-01203-3
Disclosure: Nothing to disclose.
P312 | Nightmares and anxiety upon
awakening during the crisis caused by the
Covid-­19 pandemic
I. Saez-Uribarri
Onirotest, Bilbao, Spain
Objectives/Introduction: To test whether the state of emergency
caused by Covid-­19 increased the number of nightmares and anxiety
upon awakening.
Methods: The latest awakening of two independent groups was
evaluated before (n = 486, 72.8% female) and during the Covid-­19
crisis (n = 616, 73.9% female). Subjects were surveyed on the same
day regarding what their dream was like, their anxiety upon awak-
ening, and various aspects of the Covid-­19 crisis. Data collection
was anonymous, over the internet, and aimed at Spanish speakers.
A nightmare was defined as a dream which awoke the subject, with
recall of at least one dream scene with fear or anxiety. Additionally,
subjects completed the Anxiety upon Awakening Assessment
Questionnaire (CEAD, as per the Spanish acronym).
Results: In the Covid-­19 group, 54.1% of awakenings included dream
recall and 1.3% included a nightmare. Differences were found be-
tween the samples in several respects: age, longer sleep time, a longer
time passed from when they awakened to when they answered the
ABSTRACTS
questionnaire, they woke up with an alarm more frequently and they
took more medication. After eliminating these biases, the partial
correlation (rp) between the groups and nightmares was not sig-
nificant (r p  =  −0.02, df  =  1061, p = 0.413). A number of findings
explained this result: subjects in the Covid-­19 group recalled their
dreams less (Chi-­Square = 15.07, df = 5, p = 0.010), they did not feel
greater fear or anxiety upon awakening (Chi-­Square = 5.12, df = 1,
p = 0.275), and they did not classify their dreams as nightmares (Chi-­
Square = 3.46, df = 1, p = 0.178). The correlation between the groups
and the CEAD was significant (r p = 0.09, df = 1061, p = 0.004). The
aspects which contributed to an increased CEAD score were: the
frequency (Chi-­Square = 116.70, df = 4, p < 0.001) and intensity (Chi-­
Square = 100.93, df = 4, p < 0.001) of worrying, and considering
themselves part of an at-­risk group due to age
(Mann-­Whitney U = 14286, p = 0.003), prior illness (Mann-­Whitney
U = 18801, p = 0.019) or other reasons (Mann-­Whitney U = 23999,
p = 0.031).
Conclusions: It was not possible to confirm that the crisis caused
by the Covid-­19 pandemic increased the number of nightmares. In
general, anxiety upon awakening increased as a result of worrying
and perceived risk.
Disclosure: Nothing to disclose.
P313 | Spectral EEG bands and dreams
J. Pires1; T. Paiva2
1
Lisbon School of health Technology, Amadora; 2CENC, Lisboa,
Portugal
Objectives/Introduction: We aim to analyse the topography of EEG
spectral bands before REM sleep and according to their emotional
content.
Methods: 20 adult healthy women without medical-­psychiatric dis-
orders or medication were recorded for 2 consecutive nights PSG
included 21 EEG channels and standard poligraphic channels. REM
awakenings dreams were collected after 10 continuous minutes of
uninterrupted REM. REM Dream contents were evaluated by the
Hall van Castle method.
Mapping of the spectral components of conventional EEG bands
(delta, theta, alpha, sigma, beta and gamma) was performed for the
10 minutes prior to the forced awakenings.
Normality was tested for each variable before further analysis Cases
of dream report were compared to published normative Hall and Van
Castle data, statistical analysis was based on frequencies and com-
parisons of percentages through the ‘h’ statistic (Cohen). the results
were considered significant for p less than 0.05.
Results: 20 women were admitted in our study with mean age of
27,7 (min 20; max 36).
127 REM awakenings were performed, with 82,9% recall rate; 105
dreams were evaluated (5.25 per subject, min 2; max 9; mean = 1,38;
SD = 1,90).
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Dreams were evaluated with the Hall and Van Castle Scale, in what
concerns emotions, there was a lower percentage of dreams with
described emotions (p = 0.025), a higher percentage of dreams with
emotions related to the dreamer (p = 0.007) and a lower percentage
of negative emotions associated with the dreamer (p = 0.025)
The 6 spectral bands studied, changed over time and with the exist-
ence of reporting (p < 0.001). The various spectral bands seem to
evolve according to rhythm behind which is attenuated in the pres-
ence of dream recall.
Conclusions: The various spectral bands seem to evolve according to
rhythm behind which is attenuated in the presence of dream recall,
suggesting the existence of Infra Slow Oscillations (ISO) in REM.
The observed ISO (0.0067 Hz) is much lower than the ISO in NREM.
It possibly represents the Default Mode Network in REM sleep
which is attenuated, as in wakefulness, by the cognitive activity of
dreams.
Disclosure: Nothing to disclose.
P314 | Sleep deprivation as a remedy for major
depression: biochemical mechanisms
A. Ancyborov1,2; V. Alekseev1; A. Kalinchuk 2,3
1
Rostov State Medical University; 2Medical Sleep Center ‘Yug-­Clinika’;
3
Southern Scientific Center of Russian Academy of Science, Rostov-­on-­
Don, Russian Federation
Objectives/Introduction: Major depression (MD) is a second leading
cause of disability worldwide. Presently, there is a strong need for
developing fast-­acting antidepressants. Sleep deprivation (SD) has
been shown to provide fast antidepressant action in clinical trials,
however, the neurobiology of this effect is not well understood. We
hypothesize that SD induces antidepressant effects via restoring the
balance between excitatory and inhibitory neurotransmitters/neu-
romodulators in the prefrontal cortex (PFC), area critical both for the
development of MD and homeostatic sleep control.
Methods: We developed rat models of depressive-­like (DL) behavior
using chronic social defeat stress (ChSDS) paradigm. Male rats (n = 4)
were surgically implanted with electrodes for recording electroen-
cephalogram/electromyogram and bilateral microdialysis cannulae
targeting PFC. Microdialysis samples were collected before and
after subjecting animals to ChSDS paradigm
(BL and DL-­BL days) and during/after SD for 6 h (DL-­SD day). The
antidepressant efficiency of SD was confirmed using standard
behavioral tests. The levels of glutamate (Glut), aspartate (Asp),
gamma-­amino butyric acid (GABA) and adenosine (Ado) were meas-
ured using high performance liquid chromatography (HPLC).
Results: ChSDS paradigm for 2 weeks led to the development of
DL-­behavior as indicated by decreased performance in forced swim-
ming, elevated maze, open field and sucrose preference tests. SD
significantly improved the performance as compared to DL-­BL day.
We found that DL-­behavior was associated with the increase in the
 |
224 of 356       ABSTRACTS
levels of Glut and Asp: on DL-­BL day Glut was increased by 26.4% as
compared to BL (paired t-­test, p = 0.008), Asp -­by 24.7% (p = 0.04). In
contrast, the levels of GABA and Ado were decreased as compared
to BL: GABA -­by 25.4% (p = 0.34) and Ado -­by 30.2% (p = 0.002). SD
restored ChSDS-­induced imbalance: as compared to DL-­BL day, on
DL-­SD day the levels of Glu and Asp were decreased by 21.4% and
22.7% (p ≤ 0.02) and GABA and Ado were increased by 18.7% and
24.3% (p ≤ 0.009), respectively.
Conclusions: Our data suggest that DL-­behavior is associated with
the increase in the levels of Glut and Asp and decrease in the levels
of GABA and Ado in the PFC. SD might provide fast antidepressant
effect by decreasing the levels of excitatory and increasing the levels
of inhibitory neurotransmitters/neuromodulators.
Disclosure: Nothing to disclose.
P315 | Aqueous extract of Terminalia chebula
and Allophylus serratus improves sleep quality
with brain metabolites level in male rats
P. Kumar
University College of Medical Sciences (UCMS), Delhi, India
Objectives/Introduction: Sleep deprivation (SD) has been shown to
induce oxidative stress which causes cognitive impairment The pre-
sent study was performed to investigate the effects of Terminalia
chebula (TC) and Allophylus serratus (AS) leaves extract on sleep-­
wake profile and level of brain monoamines on Wistar male rats.
Methods: Electrodes and transmitters were implanted to record
EEG and EMG in freely moving condition and the changes were re-
corded telemetrically after oral administration of TC and AS extract
in the doses of 50, 100 and 300 mg/kg body weight. The open field
test and Morris water maze were used to evaluate cognitive abil-
ity. The expression of brain-­derived neurotrophic factor (BDNF) and
calcium-­calmodulin dependent kinase II (CaMKII) proteins in CC and
hippocampus was assayed by means of immunohistochemistry.
Results: Sleep latency was decreased and duration of non-­rapid eye
movement (NREM) sleep was increased in a dose dependent man-
ner. A significant decrease of sleep latency and duration of wakeful-
ness were observed with TC and AS extract at doses of 300 mg/kg.
Duration of NREM sleep as well as duration of total sleep was in-
creased significantly after treatment with both extracts at the doses of
100 and 300 mg/kg. Both TC and AS extract also increased EEG slow
wave activity during NREM sleep at the doses of 100 and 300 mg/kg.
Level of norepinephrine (NE), dopamine (DA), dihydroxyphenylacetic
acid (DOPAC), serotonin (5-­HT) and hydroxy indole acetic acid (HIAA)
were measured in frontal cortex and brain stem after TC and AS ex-
tract treatment at the dose of 100 mg/kg. NE and 5HT level were
decreased significantly in both frontal cortex and brain stem. DA and
HIAA level significantly decreased only in cortex. DOPAC level was
not changed in any brain region studied. The results of immunoreac-
tivity showed that SD decreased gray values of BDNF and CaMKII in
CC and hippocamal CA1, CA3 and dentate gyrus regions, whereas TC
and AS extracts improved the gray values
Conclusions: In conclusion it can be said that both TC and AS extract
has a sleep quality improving effect which may be dependent upon
levels of metabolites in cortex and brainstem.
Disclosure: Nothing to disclose.
P316 | Effect of Sudarshan Kriya Yoga on sleep
propensity in novice practitioners
K. Chaudhari1; S. Chaudhari1,2; H. Rankhambe3,4; V.
Kochupillai4,5,6; R. Tiwari7
1
Department of Internal Medicine, Surana Sethia Hospital & Research
Centre; 2Department of Internal Medicine, Seth Gordhandas Sunderdas
Medical College; 3Department of Physiology, Topiwala National Medical
College, Mumbai; 4Art of Living Foundation, Bengaluru; 5Department
of Medical Oncology, All India Institute of Medical Sciences, New
Delhi; 6Sri Sri Institute for Advanced Research, Ved Vignan Maha Vidya
Peeth, Bengaluru; 7Department of Samhita Siddhanta, Smt. K.G. Mittal
Punarvasu Ayurvedic College, Mumbai, India
Objectives/Introduction: Hectic, late-­
night lifestyle has reduced
90 minutes sleep in 20% adults resulting in insomnia and excessive
daytime sleepiness (EDS). Pharmacotherapy is expensive, causes
rebound insomnia, dependence, disturbed sleep and cognition with
no preventive value. We assess the scope of Sudarshan Kriya Yoga
(SKY), a 4-­component, breathing process in reducing EDS both gen-
erally and situationally.
Methods: This is a prospective, controlled study involving subjects
without any sleep-­wake cycle anomalies and prior experience in
SKY. Subjects (n = 52) performed 30 min of SKY for 6 days/week
for 8 weeks, while controls (n = 53) sat in chair and performed
Suryanamaskar for 4-­weeks each. Epworth Sleepiness Scale (ESS), a
subject-­rated, 8-­item questionnaire scored between 0-­24 at 0, 4, and
8 weeks was used to measure EDS.
Results: SKY group showed significant ESS score improvement
between 0–4 weeks and 4–8 weeks of 1.22 (p = 0.0001) and 1.66
(p = 0.001) respectively. However, controls failed to improve with re-
spective score differences of 0.02 (p = 0.892) and 0.02 (p = 0.8212).
Although baseline SKY and control groups showed no significant dif-
ference in ESS scores, SKY group showed significant improvement
over controls at 4-­weeks (difference = 1.74; p = 0.013) and further
so at 8-­weeks (difference 8; p = 0.0001). Improvement was most for
obese people and those sitting in a halted car.
Conclusions: Improvement in subjects’ nighttime sleep and daytime
wakefulness in SKY practitioners can be attributed to the resistive
(Ujjayi) breathing which promotes predominantly vagal and sympa-
thetically quiescent activity (polyvagal theory). This counters the
increased alterations in heart rate variability (HRV) and sympathetic
hyperarousal in chronic insomnia; cholinergic and GABAergic dys-
regulation in anxiety disorders; ultimately improving sleep quality.
ABSTRACTS
Detailed understanding of the mechanisms by which SKY benefits
sleep can be studied using polysomnography especially in subjects
with established sleep disorders and a larger sample size.
Our study establishes the usefulness of SKY in reduction of EDS,
confirms that positive polysomnographic findings of our predeces-
sor translate into reduced daytime sleep and also eliminates the am-
biguity of their equivocal results. Exercise prescriptions for insomnia
and sleep-­wake cycle disorders can utilize SKY as an inexpensive and
preventive or therapeutic adjunct with further targeted research.
Disclosure: Nothing to disclose.
P317 | Relationship between waking theta
power and the present and prior sleep wake
activity
Z. Lelkes
Department of Physiology, University of Szeged, Szeged, Hungary
Objectives/Introduction: Waking EEG rhythmic (hippocampal) theta
activity is associated to behavioral activation, but it was also proposed
as an indicator of sleep propensity. To clarify whether high theta activity
is a sign of arousal or a high sleep pressure (Process S) the relationship of
theta activity to the present and prior sleep-­wake activity was studied.
Methods: The experiments were performed on 7 male Sprague-­
Dawley rats with implanted EEG electrodes. The animals were kept
under conditions of controlled temperature (24 + 1°C) and lighting
(lights on 8:30–20:30 h). EEG and Sleep-­wake activity was recorded
for 48 h. The percentages of vigilance states and the high frequency
theta (6–9 Hz; corresponding to rhythmic hippocampal theta activ-
ity) power of the EEG during wakefulness (W) were calculated for
consecutive 3-­h periods. A cumulative curve of the time spent in W
was constructed. Then a regression line was fitted to the cumula-
tive curve and it was calculated, how much each point of the curve
was above or below the regression line. This distance was regarded
to be the measure of W excess/deficit. This W excess/deficit value
(corresponding to sleep deficit/excess) was declining and increasing
during almost the entire light and dark phases of the day respec-
tively. (Previously we have found, that the prior sleep-­wake activity
assessed by a similar method correlated with the delta power dur-
ing non-­REM sleep.) The correlations between theta powers and the
percentages of the given time periods spent in W and between theta
powers and the W excess/deficit values were calculated.
Results: W theta power correlated with both the amount of W dur-
ing the given time period (r = 0.45, p < 0.05) and the W excess/deficit
value (r = 0.39, p < 0.05). Theta power was higher during the dark
phase of the day than during the light one (t-­test, p < 0.05).
Conclusions: Rhythmic theta activity is a sign of arousal. Following
long periods of W, a stronger arousing action is necessary to over-
come the high sleep pressure (Process S) and keep the animal awake,
this is indicated by the high theta power.
Disclosure: Nothing to disclose.
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P318 | Can auditory slow wave stimulation
during chronic sleep restriction intensify
subjective recovery?
N. Schneider1; M.L. Ferster2; C. Lustenberger2; J. Schlegel1;
W. Karlen2; R. Huber3,4; C.R. Baumann1; A. Maric1
1
Department of Neurology, University Hospital Zurich, University of
Zurich; 2Department of Health Sciences and Technology, ETH Zurich;
3
Child Development Centre, University Children's Hospital Zurich;
4
Department of Child and Adolescent Psychiatry, University of Zurich,
Zurich, Switzerland
Objectives/Introduction: Insufficient habitual sleep duration, namely
chronic sleep restriction (cSR), reduces the opportunity for restora-
tion associated with sleep and leads to a homeostatic increase in
sleep pressure. Auditory stimulation (AS) during sleep can be used to
enhance slow waves (SWs), which are associated with the restorative
function of sleep. However, it is unclear whether AS is also effective
in the presence of increased sleep pressure which could constitute
a ceiling effect. Furthermore, we do not know whether such an en-
hancement could counteract negative effects of cSR.
Methods: In this ongoing study (current n = 10), young male subjects
underwent 2x7 nights of cSR with nightly up phase targeted AS in
one week (stim) and muted AS in the other week (sham) in a counter-­
balanced order. AS was enabled (ON) and disabled (OFF) every 6 sec-
onds, resulting in alternating windows with and without stimulation.
Slow wave activity (SWA; spectral power 0.5–4.5 Hz) increase was
calculated as the relative difference between ON and OFF windows.
The subjective recovery in the mornings was assessed with visual
analogue scales (100% = feeling perfectly recovered). Data were
compared using a mixed model including factors condition (sham vs.
stim), day (1–7) and order of conditions.
Results: SWA increase was significant in the stim (+28.10 ± 2.03%)
compared to the sham week (−1.15  ±  0.49%; p = 0.02, mean in-
crease across nights ±SEM). Although subjective recovery did not
differ significantly between conditions (sham: 61.10 ± 2.12%, stim:
64.86 ± 2.1%; p = 0.09, mean across nights ±SEM), there was a sig-
nificant interaction between day and condition (p = 0.036): Whereas
in the sham condition the extent of feeling recovered decreased
throughout the cSR week (first 2 nights: 75.6 ± 2.11%, last two
nights: 50.6 ± 5.60%; p = 0.002), this was not observed in the stim
condition (68.3 ± 4.8% versus 63.5 ± 4.9%; p = 0.25).
Conclusions: Our preliminary results show that AS enhances SWA even
under cSR. Furthermore, the otherwise observed reduction in subjec-
tive recovery evolving during cSR was mitigated by AS. Albeit very pre-
liminary, this indicates that AS may enhance the restorative function
of sleep. Future analyses will show to what degree subjective ratings
directly relate to electrophysiological and behavioural measures.
Disclosure: Nothing to disclose.
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226 of 356       ABSTRACTS
P319 | Sleep apnea and heart shock protein 70
(HSP 70): pilot study
I. Madaeva; N. Kurashova; N. Semenova; S. Kolesnikov; V.
Madaev; L. Kolesnikova
Scientific Сentre for Family Health Problems and Human Reproduction,
Irkutsk, Russian Federation
Objectives/Introduction: Nocturnal intermittent hypoxia in ob-
structive sleep apnea (OSA) causes the stress and as a response to it
change in inducible HSP 70 level should be expected. Thus, relation-
ship of the nocturnal hypoxia and serum HSP 70 level assessment in
patients with severe OSA was the aim of this study.
Methods: The study involved 38 patients with clinical diagnosis of mod-
erate and severe OSA (28 male and 10 female). Patients without OSA (10
male and 5 female) were included as a control group. The groups were
similar in mean age. The polysomnographic monitoring was carried by
standard methodology. Blood serum was sampled between 8.00 and
9.00 a.m. after polysomnographic testing to determine the HSP 70 level.
Results: The results of this study demonstrated high apnea/hypo-
pnea index (AHI), which determine the OSA severity and decrease
blood SaO2 (p < 0.05). Sleep fragmentation in patients with OSA
confirms the increase in respiratory ArI. The HSP70 level signifi-
cantly increased in patients with OSA compared to control group.
Correlation analysis showed a positive relationship between HSP70
and AHI (R = 0.5) in patients with OSA, as well as a negative relation-
ship between HSP70 and the SaO2 level (R = −0.35).
Conclusions: Our data proved that in patients with severe OSA the
Hsp70 level is higher than in people without OSA. Thus, the direct
correlation between the HSP 70 level and AHI and the feedback cor-
relation with the SaO2 level found. These data convincingly prove
the interrelation between inducible HSP 70 level and nocturnal hy-
poxia in OSA patients.
Disclosure: The authors report no conflicts of interest.
P320 | Entrainment of the circadian system to
an extremely long photoperiod: summer camping
at high latitude (~63°n)
1,2 1,3 3
J.R. Guzzetti ; T. Sundelin ; B.C. Holding ; K.P. Wright;
Jr2; J. Axelsson1,3
1
Stockholm University, Stockholm, Sweden; 2University of Colorado
Boulder, Boulder, CO, United States; 3Karolinska Institute, Stockholm,
Sweden
Objectives/Introduction: The human circadian clock is sensitive
to the photic alterations of the natural light-­dark cycle, and it is
finetuned across seasons so that the biological night is shorter in
summer compared to winter, although data show that this seasonal
entrainment is less robust in environments with electrical-­lighting.
Here we aimed to determine how the circadian system and sleep
entrains to long photoperiods occurring during summer, with and
without modern electrical lighting.
Methods: Eleven healthy adults (average age 29 years, 4 females)
were exposed to two different light exposure conditions. The first
week, beginning just after summer solstice, latitude ~59°N (18 h
37 min, 5 hr 23 min natural light-­dark (LD) cycle) in modern envi-
ronment with exposure to natural light and electrical-­lighting. The
second week was spent camping in natural light at higher latitude
~63°N (LD-­cycle 20 hr 10 min: 3 hr 50 min natural light-­dark cycle).
Participants maintained self-­
chosen sleep timing throughout the
protocol and a 24 hr assessment of melatonin rhythms was con-
ducted in the laboratory following each week of the protocol.
Results: Exposure to a long summer photoperiod while camping
restricts the biological night duration, resulting in the end of the
biological night occurring closer to sleep end after only natural light
exposure as compared to modern electrical-­lighting. Sleepiness and
mood were improved during the camping week, but sleep timing was
not significantly affected. We also found that sleep begins during
the incline in distal skin temperature in the natural environment with
exposure to only natural light.
Conclusions: While there was a clear reduction of the biological
night after a weeks exposure to an extremely long photoperiod with
natural light, melatonin release was still produced for many hours
longer than the photoperiod of 20 hours. This supports that the
circadian system is robust also to extreme light conditions, which
may explain why sleep duration and quality remained of high quality.
Camping also reduced sleepiness and improved mood indicating that
natural light has positive effects for wellbeing also when photoperi-
ods are extremely long.
Disclosure: Nothing to disclose.
P321 | Assessing the predictive potential of
neck circumference for diagnostic and CPAP
treatment response in OSAS with network
medicine
S. Mihaicuta1; A. Topirceanu2,3,4; L. Udrescu2; M. Udrescu4
1
Pulmonology; 2Victor Babes University of Medicine and Pharmacy;
3
Cardioprevent Foundation; 4Timisoara Politechnik University,
Timisoara, Romania
Objectives/Introduction: We aim to explore the relationship be-
tween the anthropometric measures of patients with obstructive
sleep apnea syndrome and their response to CPAP treatment.
Methods: We employ an interdisciplinary, network medicine ap-
proach. To this end, we process three non-­overlapping cohorts to-
taling 1046 patients from 4 sleep laboratories in Timisoara, Western
Romania, out of which 145 subjects having a one-­night CPAP therapy.
Using one cohort, we create a compatibility network of patients with
the recorded data, then validate the results of our network analysis
ABSTRACTS
on the other two cohorts (OSAS-­diagnosed and control groups), with
area under the curve derived from the receiver-­operating character-
istic curve.
Results: Our analysis uncovers four emergent network communi-
ties classified in two CPAP response classes. We show that neck cir-
cumference (NC) does not predict as significant CPAP response for
women, whereas more than 90% of male patients with a large neck
present a significant apnea-­
hypopnea index (AHI) improvement.
Moreover, the statistical analysis finds a significant correlation be-
tween NC and AHI (ρ= 0.35, p < 0.001). The area under the curve of
0.71 (95% CI 0.63–0.79, p < 0.001) indicates that 71% of diagnosed
male subjects have a bigger NC than subjects with no sleep apnea.
The optimal NC cut-­off value is 41 cm, with a sensitivity of 0.8099,
specificity of 0.5185, PPV = 0.9588, NPV = 0.1647, and LR+=1.68.
We validate the statistical results back on the CPAP network and
show that the predictor NC > 41 cm is able to correctly classify
patients based on CPAP response with a sensitivity of 0.913 and a
specificity of 0.859.
Conclusions: Neck circumference is an easy-­to-­measure parameter
and a reliable risk indicator for patients suspected with obstructive
sleep apnea. Additionally, our Network Medicine analysis has uncov-
ered that NC > 41 cm is a robust predictor for an efficient CPAP
treatment response, predominantly targeted at the prioritization of
male patient treatment.
Disclosure: Nothing to disclose.
P322 | Validation study of an innovative device
to screen sleep respiratory disorders
A. Braghiroli; C. Sacco; M. Godio; F. Rossato; S. Rossi; S.
Carli; A. Agazzone; E. Morrone
Respiratory Disease, ICS Maugeri SpA SB IRCCS Veruno, Gattico-­
Veruno, Italy
Objectives/Introduction: A simple and reliable screening tool is a
real need to couple the epidemiology of obstructive sleep apnea
(OSA) with the resources available in sleep laboratories, particu-
larly in patients with OSA and comorbidities who often do not have
symptoms (i.e.: somnolence).
Objective of this study is to test the reliability of a simple screening
tool in allocating patients to mild, moderate or severe OSA group vs
standard cardiorespiratory monitoring.
Methods:: AirGo™ is an innovative device consisting of a comfort-
able elastic band and a microprocessor to be positioned in the lower
chest which continuously calculates tidal volume and respiratory
rate. The occurrence of respiratory events during sleep is based on
the reduction of minute ventilation and the automatic analysis dis-
criminates central and obstructive events offering an apnea/hypo-
pnea index (AHI) at every 10% of ventilation reduction. We tested
the device in 100 consecutive patients (19 females) simultaneously
undergoing a cardiorespiratory monitoring (Nox T3). The sample
|
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exceeds the numerosity required by power analysis requiring 40
patients based on Alpha 0.05 power 80% p < 0.05 considering an
SD ± 10 events. The trend of AHI In the deciles 30–50% is the best
descriptor of respiratory disorder.
Results: The mean age of pts (± SD) is 55.2 ± 14 yrs, BMI 27.8 ± 4.2 kg/
m2, AHI 21.3 ± 20.4 events/hr. AirGo™ correctly allocated to the se-
vere group 33 out of 34 patients (PPV 97% NPV 100%) and 21 out
of 31 patients with AHI < 10. In 17 pts AirGo™ showed an irregular
trend, caused by a coexisting disorder (i.e.: myoclonus, insomnia),
and in the other pts scored a mild-­to-­moderate OSA.
Conclusions: AirGo™ is a promising screening tool to stratify the oc-
currence of respiratory sleep disorder, identifying pts with severe
OSA, pts without RBD, pts with irregular breathing and with mild-­
to-­moderate disease.
Disclosure: Nothing to disclose.
P323 | Oxygen desaturations index (ODI)
as a marker for intermittent hypoxia and its
relationship to cardiovascular risk factors
R.C. Mateo-Montero1; A. Gomez Dominguez2; A. Cid2;
A. Pedrera Mazarro2; E. Llado-Carbo1; R. Sola1; G.
Martin-Palomeque2
1
Hospital HM Delfos, Barcelona; 2Hospital Universitario Ramon y Cajal,
Madrid, Spain
Objectives/Introduction: Sleep apnea and hypopnea syndrome
(SAHS) is very prevalent and has been described linked to several
diseases including cardiovascular disease which is a serious public
health problem. The physiopathological mechanism of this associa-
tion in part to intermittent hypoxia (IH), so it is necessary classifica-
tion and categorization.
Currently, the AHI is used in the neurophysiological diagnosis of the
SAHS, which is a good indicator and meter of severity, but is it an
adequate meter of the entire physiopathology of the I?SAHS? does it
directly measure the IH? does it adequately discriminate the degree
of desaturation?
The main objective of our work is to evaluate the oxygen desatura-
tion index (ODI) as a more objective marker of IH.
Methods: We presented an observational retrospective study that
evaluated 111 adult patients with SAHS from two hospitals in Spain
(Ramon y Cajal Madrid and HM Delfos Barcelona), who had under-
gone a PSG between the years 2017–2020, in which we analysed
the correlation of T90, ODI and IAH and the relationship with car-
diovascular risk factors (CRF) We also assessed other factors such as
obesity and the symptoms presented by our patients
Results: The patients were divided into 3 groups according to the
ASO severity: mild: 45, moderate: 22 and severe 33; 86 had a high
ODI and 68% were asymptomatic in wakefulness. There was a posi-
tive linear correlation between ODI and HAI (r = 0.92) and between
HAI and T90 (r = 0.73), although of lower intensity. Of the patients
 |
228 of 356       ABSTRACTS
66 had CRF of which 22 had severe SAHS, 19 moderate and 25 mild
but 64 with high ODI. 68.2% of patients with mild ASO SAHS re-
ceived no treatment and of these
Conclusions: In conclusion, SAHS has a high association with CRF
but most patients are asymptomatic in wakefulness, which makes
treatment decisions difficult. On the other hand, ODI is a good
measure of HI. Therefore, we suggest that ODI is as valuable as
IAH, and could help us to better explain the physiopathology of the
disease and its classification to improve diagnosis. Therefore, one
should consider the probability of treating patients with mild and
moderate SAHS with elevated ODI even if they are asymptomatic in
the wakefulness.
Disclosure: Nothing to disclose.
P324 | Electroencephalographic findings during
sleep in apneic obese adolescents
O. Berdina; I. Madaeva; S. Bolshakova; L. Rychkova
Scientific Centre for Family Health and Human Reproduction Problems,
Irkutsk, Russian Federation
Objectives/Introduction: Sleep-­
disordered breathing (SDB) with
apnea episodes involves intermittent nocturnal hypoxemia and fre-
quent arousals. The aim of this study was to explore specific sleep
encephalographic (EEG) patterns in obese adolescents with SDB
using polysomnography (PSG).
Methods: We examined 30 obese (18 apneic and 12 non-­apneic)
adolescents aged 15–17 years. The body mass index (BMI) was cal-
culated and subjects were classified as obese if BMI > 95th percen-
tile). PSG was performed using the GRASS-­TELEFACTOR Twin PSG
(Comet) c As the amplifier 40 with an integrated module for sleep
SPM-­1 (USA). SDB was identified if apnea/hypopnea index was ≥ 2
number/hour. The standard international 10–20 system electrode
placement and six EEG derivations (Fp3-­A 2, Fp4-­A1, C3-­A 2, C4-­
A1, O1-­A 2, and O2-­A1) were used for assess sleep EEG patterns.
Differences were reliable at p < 0.05.
Results: Sleep EEG analysis showed the following EEG patterns
in OSA patients: Pattern 1 -­lowered dominant EEG frequency
(6.2 ± 0.25 Hz vs. 10.2 ± 0.56 Hz in non-­apneic adolescents, p = 0.012)
with periods of hypersynchronous theta EEG activity; Pattern 2 -­
«alpha-­delta sleep» phenomenon in non-­rapid eye movement sleep
in 55.5% apneic patients vs. nobody in obese controls (p = 0.002);
Pattern 3 -­altered sleep spindles number and density (698 ± 167 n
vs. 213 ± 52 n in non-­apneic patients, p < 0.001; and 4.2 ± 0.9 n/30 s
epoch vs. 1.3 ± 0.2 n/30 s epoch, respectively, p = 0.035); Pattern 4
-­altered cyclic alternating pattern subtypes A2 in 39 % apneic ado-
lescents vs. nobody in non-­apneic controls (p = 0.014).
Conclusions: Altered EEG patterns in obese apneic adolescents can
be seen as adaptive responses to multiple brief occlusions and noc-
turnal hypoxia. Future studies evaluating sleep EEG findings after
treat of SDB in obese adolescents will be needed.
Disclosure: Nothing to disclose.
P325 | Comparison of multiple sleep disorder
questionnaires as stand-­alone sleep surveillance
tools
K. Chaudhari1; S. Chaudhari2; R. Sharma3; Y. Pawar4; N.
Tiwari5; P. Rathore5,6; R. Tiwari7
1
Department of Neurology, University of Oklahoma Health Sciences
Center, Oklahoma City, OK, United States; 2Department of Internal
Medicine, Seth Gordhandas Sunderdas Medical College, Mumbai, India;
3
Department of Neurology, University of Arkansas for Medical Sciences,
Little Rock, AR, United States; 4Department of Psychiatry, Dr. V.P.
Medical College Hospital and Research Centre, Nashik; 5Department of
Internal Medicine, Byramjee Jeejeebhoy Medical College, Pune, India;
6
Department of Internal Medicine, Danbury Hospital, Danbury, CT,
United States; 7Department of Samhita Siddhanta, Smt. K.G. Mittal
Punarvasu Ayurvedic College, Mumbai, India
Objectives/Introduction: Diagnostic delays of chronic sleep disor-
ders including insufficiency of sleep predispose to significant physi-
cal and mental morbidity. Considering their high prevalence (~40%),
screening of multiple sleep disorders (MSD) using a brief yet effi-
cient questionnaire at community-­level itself, is crucial to preven-
tion. We critically graded several MSD questionnaires (MSDQs) for
validity, reliability, comprehensiveness, brevity, language, statistical
evidence, and standardization in an effort to identify a stand-­alone
MSD screening tool in hands of non-­sleep physicians.
Methods: We systematically reviewed articles with English abstracts
published after 2000 from PubMed/MEDLINE, CINAHL, Scopus,
and Google Scholar for MSDQs with preference to adult studies,
self-­reportability, MSD over single disorders and psychometric vali-
dation. Further, the questionnaires were graded on a 20-­point scale
with six points for comprehensiveness, four for brevity (no. of ques-
tions: 3-­points and page count: 1-­point), eight for psychometric as-
sessment (two each for standardized questions, statistical validity,
specificity of individual item clusters, and prognostic value), and two
for optimal recall duration.
Results: An ideal sleep surveillance questionnaire should be brief,
one-­paged, could be completed in under 15 minutes, should ef-
ficiently differentiate MSD, predict need for specialized care,
and could be administered at primary care level. Sleep Disorders
Symptom Checklist-­25 (SDS-­CL-­25), a single page, 25-­item question-
naire reporting 13 disorders and four functional outcomes, recalled
over three months scored the highest at 12, albeit validation studies
were pending. Its questions were both psychometrically sound and
statistically valid. Global Sleep Assessment Questionnaire (GSAQ), a
one page, 11-­item questionnaire scored next with nine points owing
to its brevity. Although it lacked a clear distinction of circadian
rhythm disorders, it included questions on medical and psychiatric
implications of disturbed sleep. The Sleep Disorders Questionnaire
ABSTRACTS
(SDQ) had 175 questions on 12 pages and scored seven. It was
statistically validated but lost points owing to its length and poor
recall. Holland Sleep Disorders Questionnaire (HSDQ), a 32-­item,
four-­page document scored eight due to its lengthiness, and lack of
standardized wordings.
Conclusions: While SDS-­CL-­25 shows promise, addition of questions
for intrinsic sleep disorders, daytime consequences of disturbed
sleep, and better prognostic valuation are crucial to improving
community-­level questionnaires for sleep disorders.
Disclosure: Nothing to disclose.
P326 | Differential spindle expression
dependent upon thalamic nuclei lesioned by
stroke
J.L. Jendoubi1; V. Jaramillo2,3; J. Lippert1; N. Denier4;
C. Gutierrez Herrera5,6; M.H. Schmidt1,7; R. Wiest4; R.
Huber2,3; C.L.A. Bassetti1,6
1 P327 | Sleep homeostasis and excessive
Department of Neurology, University Hospital Bern, Bern;
2
Department of Child and Adolescent Psychiatry and Psychotherapy,
Psychiatric Hospital of the University of Zurich; 3Child Development
Center, University Children's Hospital Zurich, Zürich; 4Support Center
5
for Advanced Neuroimaging (SCAN); Department of Biomedical
Research (DBMR); 6Center of Experimental Neurology, University
7
Hospital Bern, Bern, Switzerland; Ohio Sleep Medicine Institute,
Dublin, OH, United States
Objectives/Introduction: Although ischemic strokes encompassing
the thalamus may be small, they have the potential for significant
clinical consequences. Thalamic strokes may alter sleep consolida-
tion. We investigated the effects of lesioned thalamic sub-­structures
on electroencephalographic (EEG) spindles, a non-­rapid eye move-
ment (NREM) sleep marker.
Methods: All-­night high-­density EEG was recorded in 37 patients;
from which 16 (48–80y.o, 12 males) presented with thalamic in-
farcts, determined by diffusion-­weighted-­images. The extent of the
thalamic lesion was quantified by a normalized atlas-­based parcella-
tion. From this subset, individual spindles (n = 24880) were detected
from NREM2-­3 epochs of 15 acute nights (2.06 ± 1.44 days) after
stroke. One subject had to be excluded due to low recording quality.
Results: As a group, the sleep architecture showed a high propor-
tion of NREM1 (mean 25.08 ± 10.69%). A state transition analysis
demonstrated that 46% of transitions from NREM2 were to NREM1,
while 15% were to NREM3. Individual spindle power, as well as spin-
dle globality (percentage of channels involved in a spindle) were
significantly reduced if the lesion encompassed either the intrala-
minar (IL), the mediodorsal (MD) or the ventral-­anterior (VA) nuclei
(two-­sample t-­tests, p < 0.001). The reduction in globality was larger
in frontal than in parietal channels (two-­sample t-­tests, p < 0.001).
The opposite effects were observed with inclusion of other tha-
lamic nuclei. Linear mixed-­
effects models further confirmed the
|
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preponderant role of distinct thalamic nuclei in the expression of
individual spindles. Moreover, the impact was significantly different
on frontal than on parietal spindles (dependent variables: power, glo-
bality; predictors: spindle types interacting with the damaged struc-
ture percentage; random effect: the subject).
Conclusions: These preliminary results suggest a differential effect
on individual spindle expression (power and globality) depending on
the specific thalamic nuclei affected. Local spindles also appeared
to be differentially affected. These data suggest that, localization of
lesioned thalamic nuclei may be key in understanding the impact on
spindle characteristics during sleep. As sleep fragmentation follow-
ing stroke was common in the observed population, further investi-
gations will be needed to clarify whether this sleep fragmentation
may disrupt normal spindle activity throughout the night or, rather, if
loss of thalamic connectivity may lead to spindle dysregulation and
thus negatively impacting consolidation of sleep.
Disclosure: Nothing to disclose.
daytime sleepiness in Parkinson disease
S.J. Schreiner; P.O. Valko; L.L. Imbach; A. Maric; L. Ballmer;
K.M. Schubert; E. Werth; C.R. Baumann; H. Baumann-Vogel
Department of Neurology and Clinical Neuroscience Center, University
Hospital Zurich, University of Zurich, Zurich, Switzerland
Objectives/Introduction: Excessive daytime sleepiness (EDS) is a
common and devastating symptom in Parkinson disease (PD), but
its etiology remains incompletely understood. According to the
two-­process model of sleep regulation, homeostatic sleep pressure
accumulates during wakefulness and resolves during sleep. This ho-
meostatic process is reflected by overnight decline in slow-­wave ac-
tivity (SWA) during non-­rapid eye movement (NREM) sleep. Here,
we tested the hypothesis that EDS in PD is associated with altered
sleep homeostasis.
Methods: Patients with PD (n = 144; females = 41%;
age = 62.2 ± 9.4 years, mean±SD) underwent polysomnography
and assessment of subjective daytime sleepiness with the Epworth
Sleepiness Scale (ESS), using ESS > 10 to define EDS. We performed
spectral analysis to quantitate SWA 0.5–4 Hz as well as power in
other classical frequency bands (4–8, 9–12, 13–20 Hz). To calculate
SWA decline, we divided NREM sleep (stages 2 and 3) into ten equal
segments. We defined SWA decline as the percentage of maximal
SWA, i.e. maximal sleep pressure, that had declined by the end of
NREM sleep (SWA decline=late SWA [averaged SWA over the last
three segments]*100/maximum SWA [averaged SWA over the seg-
ment with maximum SWA and adjacent segments]). We compared
SWA decline between patients with and without EDS and tested the
linear relationship between ESS and SWA decline.
Results: Excessive daytime sleepiness was present in 53 (37%) out
of 144 patients. Patients with EDS showed less overnight decline
 |
230 of 356       ABSTRACTS
in SWA compared to patients without EDS (48 ± 19% vs. 54 ± 18%;
p = 0.04). Greater ESS scores were associated with less SWA de-
cline in a linear regression analysis across all 144 patients (ß = 0.21,
p = 0.01). This effect remained significant after controlling for rel-
evant covariates (age, sex, disease duration, sleep efficiency, do-
paminergic and relevant sleep medications) and was absent in the
theta, alpha, and beta frequency bands.
Conclusions: We show that EDS in PD is associated with less SWA
decline, suggesting reduced sleep homeostasis in PD with EDS.
Further analyses are being carried out to establish whether altered
sleep homeostasis associates with neurodegeneration and/or may
contribute to EDS in PD through unresolved homeostatic sleep
pressure.
Disclosure: Nothing to disclose.
P328 | CSF Orexin as biomarker of
neurodegeneration: a systematic review and
analysis
E. Conole; R. Riha
University of Edinburgh, Edinburgh, United Kingdom
Objectives/Introduction: Disruption of orexin results in impaired
wakefulness and reduced episodes of sustaining sleep. In several
neurodegenerative disorders, sleep-­wake disturbance precedes the
onset of cognitive decline. The aim of this study was to evaluate the
evidence for the use of CSF orexin as a biomarker in patient with
neurodegenration.
Methods: A systematic search of CSF-­orexin levels in three different
neurodegenerative disease cohorts was performed: Alzheimer´s dis-
ease (AD), Parkinson´s disease (PD) and Huntington´s disease (HD).
We searched PubMed, EMBASE, MEDLINE, Scopus and the clinical
trials database for published and unpublished data pertaining to our
research question. Methodological quality assessment was applied
to refine the final search results. A meta-­analysis of the data was
then performed.
Results: We identified 21 studies on CSF Orexin-­A levels which
met the inclusion criteria and 19 were of sufficient quality to be in-
cluded in this study. CSF data were available on 746 patients (248
AD, 45PD, 71 HD. 382 controls). Orexin-­A levels were not useful in
distinguishing controls from patients with neurodegeneration, with
no significant differences emerging from the HD datasets and PD
cohort (p = 0.075 and p = 0.21 respectively). CSF-­orexin also not
significantly different between controls and AD patients and there
was high sample heterogeneity (I2 = 92%). Sub-­group analysis re-
vealed that within the AD cohort, CSF orexin levels were elevated
in advanced AD patients compared to controls, although this was a
small effect size (SMD = 0.28; p = 0.048).
Conclusions: At present, CSF orexin-­
A level cannot be recom-
mended as a screening tool in the diagnosis of neurodegeneration.
However, elevated orexin levels in advanced stage AD indicate that
orexin-­A levels may be more useful as a measure of disease progres-
sion. Investigation into the use of orexin-­receptor antagonists in
such cohorts to reduce wakefulness and promote sustained periods
of sleep is recommended for future studies.
Disclosure: Nothing to disclose.
P329 | Ambient bright light treatment
improved subjectively measured sleep but not
sleep measured by actigraphy in nursing home
patients with dementia: a placebo-­controlled
randomized trial
G.J. Hjetland1; E. Kolberg1; S. Pallesen2,3; E. Thun1,2; I.H.
Nordhus1,4; E. Flo-Groeneboom1
1
Department of Clinical Psychology; 2Department of Psychosocial
Science, University of Bergen, Faculty of Psychology; 3Norwegian
Competence Center for Sleep Disorders, Bergen; 4Department of
Behavioural Sciences in Medicine, Faculty of Medicine, University of
Oslo, Oslo, Norway
Objectives/Introduction: Sleep problems are prevalent among nurs-
ing home patients with dementia, with up to 70% experiencing poor
sleep. Light exposure is the main zeitgeber to the circadian system
and thus have a fundamental impact on sleep-­
wake behaviour.
Diminished light sensitivity due to high age and dementia-­related
pathology, as well as low indoor light levels in nursing homes, likely
contribute to sleep problems in this population. Thus, increasing
light exposure using bright light treatment (BLT) may represent a vi-
able non-­pharmacological treatment for sleep problems in nursing
home patients suffering from dementia.
Methods: The present study reports on the sleep outcomes (primary
outcomes) of the DEM.LIGHT trial, a 24-­week cluster-­randomized
controlled trial including 8 nursing home units and 69 resident pa-
tients. The intervention used light emitting diode technology, cre-
ating an ambient light setting of 1000lux and 6000K from 10 a.m.
to 3 p.m., and with gradually increasing and decreasing light levels
prior to and following the main treatment period. The placebo condi-
tion consisted of continuous standard light levels (~100lux, 3000K).
Sleep was assessed at baseline and at follow-­up at week 8, 16, and
24 using actigraphs (Actiwatch II, Philips Respironics) and the proxy-­
rated Sleep Disorder Inventory (SDI). Intervention effects were as-
sessed using mixed linear models, adjusting for relevant covariates.
Results: The mixed linear model analyses revealed a significant im-
provement in sleep as assessed by the SDI from baseline to week
16 and baseline to week 24, in the intervention group as compared
to the control group (p < 0.05). There were no changes in the SDI at
week 8 and no significant change in actigraphically measured sleep.
Conclusions: An ambient BLT intervention improved nurse-­rated
sleep in nursing home patients suffering from dementia but only
ABSTRACTS
after 16 and 24 weeks of treatment. These changes were not re-
flected by actigraphy.
Disclosure: Nothing to disclose.
P330 | Early-­night slow-­wave sleep
potentiation is disrupted in anti-­N-­methyl-­D-­
aspartate receptor encephalitis and schizophrenia
K. van Welzen1,2; A. Muñoz-Lopetegi1,3; M. Rosa-Justicia1,4;
H. Ariño1; E. Martinez-Hernandez1,3; T. Armangué1,3; H.
Stein1; A. Morató1; G. Sugranyes1,4; J. Castro-Fornieles1,4; J.
Dalmau1,3,5; J. Santamaria1,3; A. Compte1
1
Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS),
Barcelona, Spain; 2Amsterdam Brain and Cognition, University of
Amsterdam, Amsterdam, The Netherlands; 3Department of Neurology;
4
Department of Child and Adolescent Psychiatry and Psychology,
Hospital Clinic de Barcelona, Barcelona, Spain; 5Department of
Neurology, University of Pennsylvania, Philadelphia, PA, United States
Objectives/Introduction: Anti-­N-­methyl-­D-­aspartate receptor
(NMDAR) encephalitis (NMDARE) is a complex autoimmune disease
that associates with psychosis and sleep disturbances. Although
most patients have good outcomes, the process of recovery takes
many months, suggesting residual NMDAR hypofunction. We hy-
pothesized that NMDAR hypofunction could impair synaptic plas-
ticity mechanisms in slow-­wave sleep. We tested this hypothesis
examining whether patients with NMDARE or schizophrenia (also
associated with NMDAR hypofunction) have alterations in sleep-­
dependent plasticity.
Methods: In a longitudinal, single-­center study, NMDARE patients
(N = 25, ages 10–57, median 26, IQR [21–35]) were tested at early
stage of recovery, and 3, 6 and 12 months later. Schizophrenia pa-
tients (N  =  20, ages 14–49, median 20, IQR [17–27]) and healthy
controls (N = 22, ages 14–55, median 23, IQR [18–27]) were tested
in two sessions, with 1-­year interval. Sleep EEG recordings were ac-
quired (43-­channels at 512 Hz) following 3-­hour testing in a visuo-
motor cognitive task. N3 sleep slow waves were detected with the
YASA algorithm (https://doi.org/10.5281/zenodo.2370600), and
their individual slopes in frontal electrodes (as a proxy of synaptic
strength) were analyzed with mixed linear models. To control for
age-­related effects (Jaramillo et al. Sleep 2020, zsaa038), we used
data from healthy controls to fit a spline model and extract expected
age dependencies, and analyzed patient deviations from predictions
for neurotypical subjects of their age.
Results: Compared with controls, NMDARE and schizophrenia pa-
tients showed a reduction in the initial slow-­wave slope potentiation
phase that occurred within the first third of the night (p < 0.05). For
both patients groups, the rate of slow-­wave slope changes in later
stages of the night was similar to that of healthy controls, indicat-
ing a specific alteration in early-­night sleep plasticity mechanisms.
For NMDARE patients, the initial potentiation phase recovered
|
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towards healthy control values in subsequent experimental sessions
(p < 0.05), as their overall clinical condition improved.
Conclusions: Slow-­wave potentiation in early-­night N3 sleep is spe-
cifically impaired in schizophrenia and NMDARE patients, although
in the latter this reverses as disease improves. Sleep-­related con-
solidation mechanisms in early-­night sleep may depend on function-
ally normal NMDARs, and likely contribute to memory and learning
deficits in these diseases, while synaptic homeostatic mechanisms
would be normal.
Disclosure: Funding: Instituto de Salud Carlos III, Cellex Foundation,
La Caixa Banking Foundation, Ministry of Science and Innovation
of Spain. JD receives royalties from Athena Diagnostics for the
use of Ma2 as an autoantibody test and from Euroimmun for the
use of NMDA as an antibody test. JD received a licensing fee from
Euroimmun for the use of several synaptic receptor autoantibody
tests; he has received a research grant from Sage Therapeutics.
P331 | How did you sleep? Exploring by-­proxy
sleep assessment in a field study setup
T. Vacaretu1; S. Pillen1,2,3; A.W. Burghoorn4; M. Knufinke 4;
P. Lovei4; S. Overeem2,3; C. van derZwaluw5; T. Visser4; P.
Markopoulos1
1
Industrial Design, Eindhoven University of Technology, Eindhoven;
2
Kempenhaeghe, Heeze; 3Electrical Engineering, Eindhoven University
of Technology; 4Philips Experience Design, Philips; 5Zwaluwstyle,
Eindhoven, The Netherlands
Objectives/Introduction: Sleep is crucial for both mental and
physical health, and sleep disorders can pose a severe burden on
health-­related quality of life. Importantly, family members may be
affected by each other's sleep and wake behavior. Finally, there may
be differences in sleep perception between family members. As a
tool for future studies, we designed a concept for ‘By-­Proxy Sleep
Assessment’, namely, the rating of one's partner's or children's sleep
quality. This might provide a useful additional sleep quality measure,
especially when assessing people with difficulties reporting their
own sleep, such as children and people with intellectual disabilities
or dementia.
Methods: We used data from the FieldLab study, created to collect
data on sleep and sleep related behaviors in five households, using
an IoT ecosystem to combine subjective and objective information
from connected objects measuring variables such as sleep, physical
activity and environmental factors. A chat application enabled com-
munication between researchers and participants and qualitative
data was obtained through means of questionnaires and scheduled
chatbot messages. Participants were asked to rate subjective sleep
quality as well as the sleep quality of their partners and children on a
scale of 0 to 10 each morning.
Results: A total of 143 nights of partner By-­Proxy Sleep Assessment
were collected from three couples and 40 nights of By-­Proxy Sleep
 |
232 of 356       ABSTRACTS
Assessment for children from two couples. Subject-­proxy differ-
ences were averaged over the study period and varied between
−0.38  ±  1.32 (−3 -­ +2) and 1.23  ±  1.30 (−1 -­ +3) for partners and
−0.11  ±  0.97 (−3 -­ +2) and 0.61  ±  1.50 (−1 -­ +4) for children/par-
ents. Preliminary analysis of IoT data and qualitative measurements
through the chatbot revealed that both internal (e.g. migraines) and
external factors (e.g. room temperature) contribute to discrepancies
in sleep quality assessment by a proxy.
Conclusions: Experience sampling studies can offer a new perspec-
tive on sleep quality and sleep perception. Although the By-­Proxy
Sleep Assessment ratings already correlated rather well with the
subjects’ own ratings, the IoT data may aid in improving the reliabil-
ity of this approach.
Disclosure: Nothing to disclose.
P332 | BAMSA -­an easy method to evaluate
the possibility of sleep apnea among male
professional drivers
R. Huhta1,2; M. Partinen1,2
1
Helsinki Sleep Clinic Vitalmed Research Centre; 2University of
Helsinki, Helsinki, Finland
Objectives/Introduction: Obstructive sleep apnea (OSA) is a com-
mon disorder and can cause daytime sleepiness. Sleepiness is a sig-
nificant factor in traffic accidents. Sleep apnea is undiagnosed and
the resources for diagnosing it are limited. We introduce a simple
screening tool to estimate the likelihood of sleep apnea.
Methods: Altogether 2066 professional truck drivers received a
structured questionnaire. 175 drivers had a clinical examination and
sleep laboratory studies, which included cardiorespiratory polygra-
phy. We recognized the factors associating with apnea-­hypopnea
index and established a screening tool for sleep apnea.
Results: 1095 drivers answered the questionnaire. Cardiorespiratory
polygraphy was successfully performed on 172 drivers. We had full
data of 160 male drivers, and they were included in the analyses.
We identified the most important risk factors for sleep apnea, and
they included BMI > 30, Age > 50, Male sex, Snoring at least on one
night per week and witnessed Apneas at least sometimes. Using a
cut-­point of 4 points, BAMSA screening tool showed a sensitivity of
85.7% and a specificity of 78.8% in detecting AHI ≥ 15. The Receiver
Operating Curve (ROC) area was 0.823. We tested other screening
tools presented before, and BAMSA performed at least as well as the
other ones. We also analyzed the data by excluding gender from the
formulas and the ROC areas did not change.
Conclusions: It is important to bring new and simple tools to occu-
pational health care to predict the possibility of OSA. BAMSA seems
to be a sensitive tool in predicting sleep apnea among male profes-
sional drivers and it is very easy to use.
Disclosure: Dr. Huhta reports grants and personal fees from The
Finnish Work Environment Fund and personal grants in 2019 from
Henry Ford Foundation, Finnish Sleep Research Society and Maire
Taponen Foundation, regarding this work. Dr. Partinen reports
grants from The Finnish Work Environment Fund during the con-
duct of the study.
P333 |  ‘Dethroning the King’: comparative
sensitivity of the PVT and a behavioral sleep
resistance test to sleep deprivation in healthy
subjects and CPAP-­treatment in OSAS patients
O. Mairesse1,2; M. Windal2; B. Delwiche1; C. Colomb2; O.
Benkirane3; J. Newell2; D. Neu2,4
1
Brain, Body and Cognition, Vrije Universiteit Brussel; 2Sleep
Laboratory and Unit for Clinical Chronobiology, Brugmann University
Hospital; 3Université Libre de Bruxelles; 4Laboratoire du Sommeil,
Centre Hospitalier Interrégional Edith Cavell, Brussels, Belgium
Objectives/Introduction: The psychomotor vigilance task (PVT)
is allegedly the most commonly used measure of behavioral alert-
ness due to its high sensitivity to sleep deprivation. In this study we
compared an 8-­minute version of the PVT to the Behavioral Sleep
Resistance Test (BSRT) of similar duration in terms of sensitivity to
1) sleep deprivation in healthy subjects and 2) a single night of CPAP
treatment in patients with OSAS.
Methods: Fourteen male good sleepers enrolled in a 24-­hour sus-
tained wakefulness experiment (aged 36 ± 10.25 y). Every 2 h,
vigilance was assessed by administrating the PVT and BSRT as well
as subjective measurements of sleepiness (VAS). Twenty-­eight pa-
tients (12 females) addressed to a university sleep laboratory with
suspicion of obstructive sleep apnea syndrome (OSAS) and eligible
for CPAP treatment performed vigilance assessments by means of
vigilance analogues scales of sleepiness, the PVT and BSRT, at the
same time in the morning after a baseline PSG and after CPAP trial.
PVT and BSRT administration was counterbalanced between every
measurement session.
Results: In the first experiment, sensitivity indices defined as
the ratio of the effect size to its 95% confidence interval showed
the superiority of BSRT outcome variables compared to the PVT
(VAS = 22.45 > BSRT mean response speed (RS) = 7.36 > PVT mean
RS = 6.80 > BSRT 10% Fastest RS). In the second experiment, next
to the VAS, only the BSRT mean RS, the 10% fastest and the 10%
slowest reaction speeds for the BSRT significantly improved after
one night of CPAP (p's < 0.05).
Conclusions: Overall, subjective sleepiness scales are most sensitive
to the effects of sleep deprivation and CPAP treatment, followed
by cognitive speed measures of the 8-­minute version of BSRT and
the PVT.
Disclosure: Nothing to disclose.
ABSTRACTS
P334 | Dynamics of daytime multiple sleep
latency tests in individuals with different PER3
VNTR genotypes
E. Lambot1; V. Muto1; M. Jaspar1; C. Meyer1; F. Collette1; C.
Schmidt1; S. Archer2; D.-J. Dijk 2; P. Maquet1; G. Vandewalle1
1
GIGA-­CRC-­IVI, University of Liège, Liège, Belgium; 2Sleep Research
Centre, University of Surrey, Guildford, United Kingdom
Objectives/Introduction: A variable number of tandem repeat
(VNTR) polymorphism in the gene PERIOD3 (PER3) has been associ-
ated with differences in the build-­up of sleep need. Individuals ho-
5/5
mozygous for the longer polymorphism (PER3 ) were reported to
show a faster build-­up and dissipation of the EEG slow frequency os-
cillations during wakefulness and sleep, respectively. Here, we inves-
tigated whether the dynamic of sleep latency across a normal waking
day, as probed through the multiple sleep latency test (MSLT), would
differ across homozygous and heterozygous genotypes.
Methods: Following an in-­lab baseline night sleep at the habitual
sleep and wake up times, 364 healthy young men (18–31y) com-
pleted 5 MSLT every 2 h, starting 2 h after wake-­up time. Sleep la-
tency was determined as the time between light-­off and the first
N2 epoch. PER3 genotype was retrospectively determined in all in-
dividuals. Statistical analyses consisted in generalized linear mixed
models (GLMM) with sleep latency as dependent variable, subjects
as random factor, session as repeated factor, and genotype, age and
BMI as covariates, together with a genotype-­by-­repetition interac-
tion. At the time of submission, 247 subjects were processed (32
5/5 4/5 4/4
PER3 , 112 PER3 , 107 PER3 ; age: 22 ± 0.2y).
Results: Analyses revealed a main effect of repetition (p < 0.001) but
no main effect of genotype, age and BMI (p > 0.1) as well as no inter-
action between genotype and repetition (p > 0.1). Visual inspection
of the data suggested that, compared to PER3 4/4
, PER3
might show a longer sleep latency for the first MSLT followed by a
progressive decrease to reach shorter latencies for the last MSLT
(while PER34/5 seem intermediate). We therefore computed an ex-
ploratory GLMM on a reduced dataset, including only homozygous
individuals, which yielded a significant main effect of repetition
(p = 0.008), no main effect of genotype, age and BMI (p > 0.1), but a
significant genotype x repetition interaction (p = 0.047).
Conclusions: These preliminary results suggest that PER3 VNTR
genotypes do not differ in their sleep latency dynamics during a nor-
mal waking day when considering homozygous and heterozygous
individuals together. Processing of the full dataset is warranted to
assess whether the difference between homozygous individuals
only is statistically significant across all 3 genotypes.
Disclosure: WELBIO, FNRS, ULiège, ARC of the Wallonia Brussels
Federation, Clerdent Foundation, Reine Elisabeth
Foundation
|
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P335 | Gender differences in the adjustment to
night shift work
R. Lecca1; R. Loscerbo2; M. Figorilli1; P. Congiu1; G. Gioi1; C.
Cucca2; F. Meloni2; P. Cocco2; M. Puligheddu1
1
Interdepartmental Sleep Research Centre; 2Unit of Occupational
Medicine, Dept. of Medical Sciences and Public Health, University of
Cagliari, Cagliari, Italy
Objectives/Introduction: Shift-­
work tolerance is the ability of
workers to cope with their shift-­
work schedule with minimum
consequences on their health. Several individual factors influence
shift-­work tolerance; sleepiness and sleep quality can be used as
measures of adaptation. Females show less tolerance, which might
be in relation to differences in circadian rhythm, higher incidence of
sleep problems, different workload at home, and child care.
Aim of this study is to assess differences in shift-­work adaptation
by gender and to identify what factors would account for those
differences.
Methods: We recruited 156 workers, 91 workers from a ceramic tile
factory and 65 hospital workers, including 57 females (34%). Data on
anthropometric and lifestyle variables were gathered through a self-­
administered questionnaire, which included the Epworth Sleepiness
Scale (ESS) and the Pittsburgh Sleep Quality Index (PSQI). We used
non parametric statistics to assess the relationship between cat-
egorical variables, such as gender, marital status, workplace, and
nightshifts/month with the ESS and PSQI scores. We used logistic
regression models to predict risk of daytime somnolence (ESS ≥ 12)
and poor sleep quality (PSQI ≥ 5) as a function of age, marital status,
children, and number of nightshifts/month.
Results: The median ESS was significantly higher among women
(median = 7, interquartile [IQ] range = 5–11) than men (median = 4,
5/5
individuals IQ range = 3–8) (p =  2.47 x 10 -7), and 12.3% women had an ESS
score ≥ 11 vs 3.0% men p < 0.02). The median PSQI score was signifi-
cantly lower in women
(p = 2.14 x 10 -6), and 60% women vs 28% men had a PSQI score ≥ 6
(p = 0.0001). Day time somnolence tended to occur more frequently
among women with children who worked  ≥  7-­nightshifts/month,
although the statistical power was not enough get the support of
statistical significance.
Conclusions: Our results support previous reports suggesting a
higher prevalence of daytime sleepiness and an impaired sleep qual-
ity among female nightshift workers, which can be considered as
an indicator of poorer adaptation to shift work among this group.
Having children adversely affects adaptation among females work-
ing night shifts.
Disclosure: Nothing to disclose.
Medical
 |
234 of 356       ABSTRACTS
P336 | Sleep in the European Jackdaw (Coloeus
monedula)
D. Martinez-Gonzalez1; S.J. van Hasselt2; G.-J. Mekenkmap2;
A.L. Vyssotski3; S. Verhulst2; P. Meerlo2; N.C. Rattenborg1
1
Avian Sleep Group, Max Planck Institute for Ornithology, Seewiesen,
Germany; 2Groningen Institute for Evolutionary Life Sciences,
University of Groningen, Groningen, The Netherlands; 3Institute of
Neuroinformatics, University of Zurich, Zurich, Switzerland
Objectives/Introduction: Birds exhibit two sleep states similar to
mammalian rapid eye movement (REM) and non-­REM (NREM) sleep.
However, the amount of REM sleep is usually lower than in mammals
(Roth et al. JSR, 2006). Interestingly, the lowest (van Hasselt et al.
Sleep, 2019) and highest (Low et al. PNAS, 2008) amounts of REM
sleep are found among songbirds (Passeriformes). This interspecific
variation provides a rich resource for exploring the function of REM
sleep. However, with the exception of starlings (van Hasselt et al.
Sleep, 2019), replication studies have not been conducted by inde-
pendent laboratories. Herein, we reexamine sleep in the European
jackdaw, a passerine previously reported to sleep 6.8 h (97.6%
NREM and 2.4% REM sleep) under a 12:12 photoperiod (Szymczak,
Chronobiologia, 1986).
Methods: Epidural electroencephalogram electrodes were surgically
implanted in hand-­raised, 10-­month-­old jackdaws (N = 7). The 28
electrodes spanned the dorsal surface of both cerebral hemispheres.
A head-­mounted data logger recorded the signals at 250 Hz. A 3-­axis
accelerometer recorded changes in head position related to wake-
fulness (frequent, rapid movements) and REM sleep (head still or
dropping). 24-­h recordings (12:12 photoperiod, 21°C) were scored
in 4-­s epochs using standard criteria. A state was scored when the
majority of the signals exhibited that state for the majority of the
epoch. Aside from occasional periods of asymmetrical NREM sleep,
switches between states were largely synchronous.
Results: The jackdaws spent 12.3 ± 0.1 h awake, 9.7 ± 0.3 h in NREM
sleep, and 2.0 ± 0.3 h in REM sleep (17.0 ± 2.2 % of sleep time).
Across the night, time asleep was relatively constant, but NREM and
REM sleep, decreased and increased, respectively. Although most
(11.4 ± 0.1 h) of the sleep occurred at night, daytime sleep, com-
prised almost exclusively of NREM sleep (97.1 ± 0.7 %), occurred pri-
marily in the afternoon.
Conclusions: Compared to a previous study conducted under the
same photoperiod, jackdaws slept nearly 5 h more and REM sleep
constituted a much greater proportion of the time asleep. Hand-­
rearing, untethered recording, and higher temperatures in the pre-
sent study may contribute to these differences. Further research is
needed to identify the intrinsic and environmental factors that ac-
count for variation in sleep duration across studies of birds.
Disclosure: Nothing to disclose.
P337 | Changes in slow-­wave traveling after
phase targeted auditory stimulation of the up and
down phase of sleep slow waves
G. Sousouri1,2; E. Krugliakova1; J. Skorucak1; S. Leach1; M.L.
Ferster2; G. Da Polain2; W. Karlen2; R. Huber1,3
1
Child Development Centre, University Children's Hospital Zurich;
2
Department of Health Sciences and Technology, Institute for Robotics
and Intelligent Systems, Mobile Health Systems Lab, ETH Zurich;
3
Department of Child and Adolescent Psychiatry and Psychotherapy,
University of Zurich, Zurich, Switzerland
Objectives/Introduction: It has been shown that the sleep slow
waves can be characterized as traveling waves (TW) with distinct
properties such as the involvement of specific cortical regions, the
origin and the duration of the TW. Recently, it was demonstrated
that slow-­wave sleep can be locally manipulated using slow-­wave-­
targeted auditory stimulation (AS). In this work we explore the ef-
fects of AS targeted to the up and down phase of slow waves on
traveling characteristics.
Methods: We collected sleep hd-­EEG data of 12 healthy subjects
(~23 years old, 6 men) in three different conditions separated by
1 week; (1) no stimulation (SHAM), (2) up-­phase AS (UP), and (3)
down-­phase AS (DOWN). 1 subject was excluded due to poor sleep.
Stimulation (pink noise (1/f) tones) was applied in blocks of 6-­sec
windows alternating between windows with stimulations (ON) and
without (OFF) based on the EEG over the right pre-­frontal cortex.
We adapted the approach by Mensen et al., 2016 for the characteri-
zation of the TWs. Key adaptation was the application of magnitude
squared coherence for the detection of TW-­relevant channels.
Results: In our preliminary analysis we focused on the cortical in-
volvement in the TWs in a comparison between the conditions ne-
glecting the ON/OFF windows. In the direct comparison UP showed
a locally increased involvement of electrodes over the frontal cortex
(mean+/-­std: 8.3%+/-­2%, p < 0.05) compared to DOWN. In contrast,
in a cluster over the left occipital area involvement in UP was de-
creased compared to DOWN (−16.3%+/-­4.3%, p < 0.05). A compari-
son of UP with SHAM shows a trend for increased involvement in
the frontal (4.3%+/-­1.8%) and decreased involvement in the occipital
cluster (−9.3%+/-­5.7%), while DOWN compared to SHAM shows a
trend for decreased involvement in the frontal (−3.5%+/-­1.9%) and
increased involvement in the occipital cluster (7.4%+/-­3.1%).
Conclusions: In this preliminary work, we show for the first time how
a distinct property of the TW is locally affected after AS targeted
to the up and down phase of slow waves. Our results indicate that
up-­phase targeting may support the natural frontal predominance
of slow waves, while down-­phase targeting leads to a shift towards
more posterior involvement.
Disclosure: Nothing to disclose.
ABSTRACTS
P338 | Differences in circadian variation of
melatonin and antioxidant capacity in breast milk
according to the type of delivery
V. Martin-Carbonell1; M. Gombert1; S. Aparici-Gonzalo1,2; A.
Carrasco-Garcia1; G. Pin-Arboledas2; J. Carrasco-Luna1,3; P.
Codoñer-Franch1,4
1
Pediatrics, Obstetrics and Gynecology, University of Valencia; 2Sleep
3
Department, Quironsalud Hospital; Biotechnology, Catholic University
of Valencia; 4Pediatrics, Universitary Hospital Dr. Peset of Valencia,
Valencia, Spain
Objectives/Introduction: Melatonin, an essential circadian hormone
and a powerful antioxidant, is provided to the newborn by breast
milk in the first months of life. Previous studies have reported that
cesarean section can influence the composition of breast milk. We
studied the evolution of melatonin and antioxidant capacity in milk,
during the first month of breastfeeding, in the case of vaginal and
cesarean delivery.
Methods: 234 samples of breast milk were analyzed at three stages
of lactation: colostrum (first day after delivery), transition milk (third
day) and mature milk (30th day), from 39 healthy mothers (21 vagi-
nal and 18 by elective cesarean delivery). Melatonin concentration,
was analyzed using an immunoassay ELISA Salimetrics, and antioxi-
dant capacity was measured with the Brand-­Williams method (1995)
adapted by Gombert & Carrasco-­García (2019).
Results: In colostrum, no circadian rhythm could be evidenced in me-
latonin concentration, but a difference was observed according to
the type of delivery, with significantly higher levels in the cesarean
section group (55,6 ± 11,1 pg/ml during the day and 55,0 ± 8,1 pg/
ml during the night) than vaginal delivery (27,3 ± 6,9 pg/ml day and
40.0 ± 6,5 pg/ml night) (p = 0.01 day and p = 0.036 night). In transi-
tion milk, melatonin concentration is significantly higher during the
night than during the day in both groups (p > 0.002), and remains
higher in the cesarean (41,4 ± 4,5 pg/ml) compared to vaginal de-
livery group (28,2 ± 4,2 pg/ml) only during the night (p = 0.027). In
the mature milk, melatonin is higher during the night, with no differ-
ence between groups. In the group of mothers undergoing cesarean
section, a positive correlation was observed between the content of
melatonin and antioxidant capacity (R = 0.70) in daytime colostrum.
Conclusions: After cesarean delivery, melatonin concentration in
colostrum was higher. This difference seemed to fade away with
time, remaining only at night in the transition milk, and completely
normalized in mature milk. The surgery could be responsible for this
difference, and modulate the antioxidant synthesis after a cesarean
section. Nevertheless, in both groups, melatonin concentration dis-
played a clear circadian rhythm from the third day after delivery,
suggesting the robustness of this mechanism.
Disclosure: Nothing to disclose.
|
      235 of 356
P339 | Effects of sleep loss and time of day on
postural control: a randomized controlled sleep
deprivation versus multi-­nap study in healthy
older men and women
Z. Shabana1; A. Michalak1; V. Grove1; S. Laycock 2; L.
Johannsen3; A.S. Lazar1
1
Faculty of Medicine and Health Sciences FMH; 2Faculty of Sciences,
University of East Anglia, Norwich, United Kingdom; 3Institute of
Psychology, RWTH Aachen University, Aachen, Germany
Objectives/Introduction: Falls represent a major public health prob-
lem leading to injuries, hospitalization and reduced quality of life.
The risk of falls increases with age and frailty level. Studies suggest
that sleep deprivation increases postural instability and this effect
is greater in older individuals. While reliance on vision for postural
control increases with age, the benefit of sensory augmentation by
light fingertip haptic feedback does too. The contribution of sleep-­
wake homeostasis and circadian rhythmicity on postural control (PC)
and their interaction with sex and sensory feedback in older adults is
unknown. We aimed to investigate these effects.
Methods: Twenty-­
one healthy older participants (12 females,
age = 65 + 8) underwent a 70-­hour laboratory session in dim light
condition (< 10 lx). After a baseline night, participants were randomly
assigned into either a 40-­h sleep deprivation (SD) or a multi-­nap
(MN) sleep condition including consecutive intervals of 160-­mins
of wake and 80-­mins of sleep. Throughout the study, participants
underwent 10 consecutive PC test sessions on a four-­hourly-­basis
using a force plate, which registers body sway in terms of the disper-
sion of the Centre-­of-­Pressure (CoP), with eyes open or closed and
with or without fingertip touch. In the current analyses, we focused
on the CoP dynamics estimated through its path length and the area
of enclosing ellipse.
Results: Our multivariate analysis including test session, sleep condi-
tion, sensorial feedback, sex and age as predictors returned a main
effect (p < 0.0001) of test session on PC. Body sway presented with
highest values in the late afternoon and the morning hours. A signifi-
cant interaction between test session and sleep condition (p < 0.05)
indicated that PC was most impaired by SD during the early morning
hours. Interestingly, we also found a sex and sleep condition inter-
action (p =  0.037) indicating PC was more affected by SD in men.
Sensorial feedback, particularly fingertip touch, largely improved PC
(p < 0.0001) independent of other predictors.
Conclusions: Our preliminary results confirm earlier findings on the
effect of circadian phase and sleep pressure on PC and also suggest
that sex can modulate these effects. Our results imply that older
men characterized by disturbed sleep and early morning awakenings
are at increased falls risk.
Disclosure: Nothing to disclose.
 |
236 of 356       ABSTRACTS
P340 | Effects of official time in sleep and
circadian rhythms in elderly populations of
border towns in Spain and Portugal
M.Á. Bonmatí-Carrión1,2; J.A. Madrid1,2; M.T. Moreno-
Casbas2,3; M.-Á. Rol1,2; M. Consortium2
1
Chronobiology Lab, Department of Physiology, College of Biology,
University of Murcia, Mare Nostrum Campus. IUIE. IMIB -­Arrixaca,
2
Murcia; Ciber Fragilidad y Envejecimiento Saludable (CIBERFES);
3
Unidad de Investigación en Cuidados y Servicios de Salud, Instituto de
Salud Carlos III, Madrid, Spain
Objectives/Introduction: Human rhythmicity is subjected to three
times: environmental (natural light-­dark cycle), social (official time
and social/work schedules) and internal (chronotype). The health of
our circadian system will depend on the interrelationship between
them. Our aim in this study was to evaluate the effect of official
time (different social time) on circadian rhythmicity and sleep (inter-
nal time) in populations living in similar longitudinal locations (same
environmental time).
Methods: Elderly participants living in towns with similar longitudinal
locations in Spain (GMT + 1/+2, Huelva, Lugo, Ponferrada, N = 294,
age 71.8 ± 4.8 yr) and Portugal (GMT0/+1, Coimbra, N = 134, age
72.1 ± 4.7 yr) were ambulatorily monitored during 1 week with
Kronowise® (Kronohealth SL). Wrist skin temperature (WT), motor
activity (MA) and total and circadian light exposure (LE), as well as
inferred sleep, were evaluated. Non-­parametric analyses were per-
formed to evaluate phase, amplitude, and environmental synchroni-
zation of those rhythmic variables.
Results: All monitored variables showed a delay in Spanish popu-
lation with respect to Portuguese. Sleep, MA, integrated variable
TAP and LE were between 42 and 49 minutes delayed in Spain vs.
Portugal (p < 0.0001). Siesta was present in Spanish population (not
in Portuguese), as reflected by inferred sleep probability (around 20%
in Spain between 16:00–18:00 h). Normalized relative amplitude
was greater in Portugal than in Spain for WT, sleep and LE (p < 0.01),
while greater for MA in Spain (p < 0.001). Environmental synchro-
nization and circadianity indexes were also better in Portugal than
in Spain in terms of sleep, MA, TAP and LE (p < 0.0001). In Spain, a
bimodal pattern was observed for MA and TAP.
Conclusions: The assessed Portuguese population (GMT0/+1) pre-
sented greater amplitude, better environmental synchronization and
circadianity indexes than Spanish populations (GMT + 1/+2), which
also showed a delay in most of the variables studied. Typical siesta
was detected in Spain, as well as a bimodal activity pattern, probably
due to brake for meal. Although cultural differences cannot be ruled
out, we point out to a deleterious effect of Spanish official time, 1 h
delayed, in sleep and circadian rhythms. The greater morning light
exposure in Portugal can be essential to explain it.
Funding: POCTEP 0348_CIE_6_E; CB16/10/00239; 19899/
GERM/15; RTI2018- ­093528-­B-­I 00; 20401/SF/17
Disclosure: Nothing to disclose.
P341 | Cortisol, sleep and cognition in sickle
cell anaemia
M. Koelbel1; D. Dimitrou2; H. Stotesbury1; S. Sahota1; F.
Kirkham1
1
Developmental Neurosciences, UCL Great Ormond Street Institute of
Child Health; 2Lifespan Learning and Sleep Laboratory, UCL Institute of
Education, London, United Kingdom
Objectives/Introduction: Cortisol is critical for supporting a healthy
immune system, maintaining energy levels and cognitive function-
ing. The relationship of cortisol, cognition and sleep in sickle cell dis-
ease (SCD) is not well understood.
Methods: Participants of African heritage (Meanage = 19.37, Nmale=
16, Ncontrol = 18, NSCD= 27) were recruited from the community
in London, UK. Salivary cortisol was taken 4 times on a week day.
Sleep was measured with an Actiwatch (CamNtech) for 7 nights.
Assessment from the Wechsler Scales of Intelligence occurred
within 7 days of data collection.
Results: Both groups slept on average 6 h, but SCD experienced
greater sleep fragmentation (SF) and night wake bouts (WB) (SF;
31% & WB; 41) compared to controls (SF; 25% & WB; 34, both
p <  0.05). SCD had numerically greater sleep latency of 48 min
(range: 8 min -­3 h 6 min) compared to 35 min (range: 3 min -­1 h
55 min) for controls (p = 0.21). The mean full-­scale IQ, processing
speed index (PSI) and perceptual reasoning index (PRI) were lower
in SCD: FSIQSCD = 95 (SD = 11.8) & FSIQcontrols= 107.22 (SD = 9.55),
PSISCD = 90.56 (SD  =  13.3) & PSIcontrols= 106.78 (SD  =  10.38, both
p <  0.01) & PRISCD = 101.11 (SD  =  13.95) & PRIcontrols= 108.24
(SD  =  10.69), p =  0.06. SCD showed a flatter cortisol profile with
lower normalized cortisol in the afternoon (54%) compared to
controls (89%, p =  0.027). There was a positive correlation be-
tween morning cortisol and PRI (r (45) = 0.41, p < 0.01) and PSI (r
(45) = 0.30, p < 0.05), suggesting that greater increase in morning
cortisol might be beneficial for cognitive performance. Hierarchical
multiple regression revealed that WB and morning cortisol predict
PSI (R2 = 0.575, F (3, 41) = 6.76, p = 0.001) and PRI (R 2 = 0.514, F (3,
41) = 4.9, p = 0.005) in patient and controls.
Conclusions: Morning cortisol and WB could be contributing fac-
tors to the observed cognitive differences in SCD. Frequent WB and
SF might be an indicator of sleep disordered breathing in SCD. It is
important to understand what drives the relationship between sleep
and cognitive difficulties to develop interventions early on for chil-
dren with SCD.
Disclosure: Nothing to disclose.
ABSTRACTS
P342 | Postural aspects and polysomnography
D. Cugy
UHCC Bx, Bordeaux, France
Objectives/Introduction: The clinical observation of patients referred
for suspected sleep apnea shows similarities in different parameters.
In literature, A neck measurement greater than 42 cm is clearly identi-
fied. What about others parameters, easily assessed in clinical prac-
tice, like Cervical kyphosis, coiling, antepulsion of the shoulder.
Methods: Postural parameters are obtained in a standing position at rest,
the back aligned to a vertical plane, from the measurement of the vertical
inion distance, vertical acromion distance and hand-­to-­wall distance in
maximum antepulsion. These parameters as well as those already known
(neck and waist measurement, BMI) are correlated with the parameters
of polysomnography (apnea, desaturations, ..) and with the autonomic
parameters (RR variability, sympathovagal balance). This analysis is car-
ried out from a database of 523 patients combining polysomnographic
recordings and clinical examinations. The different parameters are com-
pared by regression calculation and analysis of variance.
Results: Significant correlations were found (p < 001) with the apnea
and desaturation indices for the parameters known as the neck and
waist circumference, the BMI. Cervical kyphosis and shoulder curl are
also correlated with the apnea index (p < 0.01) as well as with RR varia-
bility. The coiling of the shoulders is specifically correlated with the de-
saturation index (p < 0.05), at resting systolic blood pressure (p < 0.02)
and very surprisingly with periodic sleep movements (p < 0 , 01) as
well as the RR variability (p < 0.01). No significant relationship has been
identified between the antepulsion and the various parameters.
Conclusions: Patients referred for suspected sleep pathology need a
physical exam that included a global postural assessment especially
for those. who do not justify the use of CPAP or OAM. Furthers
studies are needed to determine efficacy of postural rehabilitation
on apnea syndrome.
Disclosure: Nothing to disclose.
P343 | Role of hypocretin-­orexin signaling
in autonomic cardiovascular dysfunction in
narcolepsy with cataplexy
K. Chaudhari1; S. Chaudhari2; R. Tiwari3
1
Department of Neurology, University of Oklahoma Health Sciences
Center, Oklahoma City, OK, United States; 2Department of Internal
Medicine, Seth Gordhandas Sunderdas Medical College; 3Department
of Samhita Siddhanta, Smt. K.G. Mittal Punarvasu Ayurvedic College,
Mumbai, India
Objectives/Introduction: Narcolepsy is a rare disorder character-
ized by excessive daytime sleepiness with (Na-­1/NC) or without (Na-­
2) cataplexy and decreased cerebrospinal fluid orexin A (OX-­A) levels
(≤110 pg/mL) in former. NC by itself has a very low incidence (0.74
|
      237 of 356
per 100,000 person-­years). However, its linkage to orexin and as-
sociation with autonomic regulation of heart has prompted further
investigation in pathomechanisms of sleep and heart failure. We aim
to study the role of hypocretin-­orexin signaling pathways in exacer-
bating the incident cardiovascular risk in patients with NC.
Methods: A systematic review of literature indexed in PubMed,
MEDLINE, Web of Science, EMBASE, and Scopus databases was
performed with no publication date limits and using the keywords
narcolepsy, cataplexy, orexin-­hypocretin, cardiovascular disease, and
arterial blood pressure (ABP). Articles with English abstracts were
considered for full-­text review and their bibliographies were further
screened for relevant articles. Selection criteria like demographic fea-
tures, case-­control definitions, sleep architecture, orexin levels, treat-
ment profiles, and comorbidities; cardiovascular parameters like ABP,
heart rate (HR), and sympathovagal measurements; and sleep-­related
phenomena like apnoea, periodic limb movement in sleep (PLMS), and
polysomnographic findings were scrutinized for every study.
Results: While 24-­hour circadian rhythmicity remained unaffected,
NC was associated with < 10% sleep-­time ABP drop (non-­dipper pro-
file) and elevated systolic BP during 30-­minutes after sleep onset and
90-­minutes before awakening, rapid eye movement (REM) sleep and
sleep accompanied with PLMS and apnea-­hypopnea episodes. HR is
elevated during sleep and wakefulness before sleep but it doesn´t
show the day-­night variations seen with ABP. Reduced binding of
OX-­A /B to OX-­R 2 receptors in wake-­active brain nuclei and car-
diac myocytes is key pathomechanism of cardiovascular risk in NC.
Lowering of blood pressure after OX-­R 2 blockade in animals doesn´t
translate clinically in NC suggesting that cardiovascular changes may
be due to factors beyond hypocretin deficiency, like predominant
sympathetic over vagal tone and REM-­dominant sleep architecture.
NC independently predisposes cardiovascular risk factors like sleep
apnea, obesity, and tobacco addiction.
Conclusions: Narcolepsy significantly links to heart failure, however,
its rarity, spontaneity of episodes, and translational contradictions
necessitate further systematic reviews to standardize this risk.
Disclosure: Nothing to disclose.
P344 | The association between self-­reported
short sleep duration and lipoprotein (a)
L. Korostovtseva1; A. Alieva1; O. Rotar1; M. Bochkarev1;
M. Boyarinova1; Y. Sviryaev1,2; A. Konradi1,3; E. Shlyakhto1;
ESSE-RF
1
Almazov National Medical Research Centre; 2Sechenov Institute of
Evolutionary Physiology and Biochemistry of RAS; 3ITMO University, St
Petersburg, Russian Federation
Objectives/Introduction: Lipoprotein (a) [Lp(a)] is considered a ge-
netic and causal factor for cardiovascular disease playing important
role in atherogenesis and thrombosis. The epidemiological data
about the association between sleep duration and lipid metabolism is
 |
238 of 356       ABSTRACTS
controversial. Thus, we evaluated the relation between self-­reported
sleep duration and Lp(a) as a genetic determinant of cardiometabolic
diseases.
Methods: Among 1600 participants of the population-­based sample,
we selected 1427 subjects without previously known cardiovascular
events, who answered the questions about their sleep duration, had
valid lipid profile results (total cholesterol, low-­and high-­density lipo-
proteins, Lp(a), Apolipoprotein AI (ApoAI), ApoB, ApoB/ApoAI) and did
not take lipid-­lowering drugs (mean age 46 ± 12 years). All subjects
underwent a structured interview, including questions about lifestyle,
medical history, complaints, and sleep duration (How long have you
been sleeping per night during last month?). Sleep duration was classi-
fied as follows: < 6 h/night -­ short, 6–9 h/night -­ normal, ≥10 h/night -­
long. Lipid profile included assessment of total cholesterol, low-­density
(LDL) and high-­density lipoproteins (HDL), Lp(a), Apolipoprotein AI
(ApoAI), Apolipoprotein B (ApoB) and ApoB/ApoAI ratio. For statisti-
cal analysis we used parametric statistics, frequency and contingency
analyses (Chi-­square), correlation analysis, logistic regression analysis.
Results: Overall, 73 respondents (5.2%) were short-­sleepers, and 69
(4.8%) -­long-­
sleepers. Males were slightly more prevalent among
short-­sleepers. The groups matched by age, body mass index, blood
pressure, diabetes mellitus, hypertension rate. Short-­
sleepers had
lower rates of high total cholesterol (≥5.0 mmol/l), lower Lp(a) levels
and lower rates of increased Lp(a) ≥ 0.5 g/l, higher insulin and insulin
resistance (assessed by HOMA-­IR). ApoAI, ApoB, their ratio and other
lab tests were similar in the groups. The multinomial logistic regression
demonstrated that only short sleep duration was independently (OR
0.29 95%CI (0.09; 0.91), p = 0.033) associated with Lp(a) (χ 2=41.58,
p = 0.003). Other influencing factors were smoking and HOMA-­IR. For
long-­sleepers only female sex was a significant predictor.
Conclusions: In our population-­based sample, short-­sleep duration
is associated with Lp(a). The latter might mediate the higher insulin
resistance and higher cardiometabolic risks in short-­sleepers.
(The analysis is supported by the grant of the RFFI, project #20-­013-­
00874 A).
Disclosure: Nothing to disclose.
P345 | Accelerometer-­measured catch-­
up sleep on non-­working days among older
employees
S. Myllyntausta1,2,3; A. Pulakka4; E. Kronholm5; J. Pentti2,3,6;
M. Kivimäki6,7; J. Vahtera2,3; M. Virtanen1; S. Stenholm2,3
1
School of Educational Sciences and Psychology, Psychology, University
of Eastern Finland, Joensuu; 2Public Health; 3Centre for Population
Health Research, University of Turku, Turku; 4Finnish Institute for
Health and Welfare; 5Finnish Institute of Occupational Health;
6
Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland;
7
Department of Epidemiology and Public Health, University College
London Medical School, London, United Kingdom
Objectives/Introduction: Employees may compensate for sleep loss
that accumulates during workdays with longer sleep duration on
non-­working days. We measured the prevalence of catch-­up sleep
on non-­working days using accelerometers and examined factors
that were associated with catch-­up sleep.
Methods: The study population consisted of 824 public sector em-
ployees in Finland (mean age 63 years; 85% women). Sleep duration
and in bed/out bed times were measured with a wrist-­worn tri-­axial
ActiGraph accelerometer continuously for seven days and nights. In
total, we had 1,437 person-­observations that included at least one
workday and one non-­working day with participants providing on
average 1.7 (SD 0.8) accelerometer measurements. The presence of
non-­working day catch-­up sleep was defined as having longer sleep
duration when compared with workdays.
Results: Of the 1,437 person-­observations, 78% were defined as in-
cluding catch-­up sleep and 22% as not including catch-­up sleep. Sleep
duration on workdays was below recommendations in both groups
and on average 6 h 26 min [95% CI 6 h 23 min -­ 6 h 30 min] among
those with non-­working day catch-­up sleep and 6 h 51 min [95% CI
6 h 44 min -­6 h 57 min] among those without it. These groups did not
differ from each other based on gender, occupational status, lifestyle
factors, sleep difficulties, self-­reported insufficient sleep, or daytime
tiredness. The prevalence of job strain (high job demands and low
job control) was higher in the non-­working day catch-­up sleep group
(21%) than among those without non-­working day catch-­up sleep
(16%). There were no differences in workday sleep duration among
those with and without job strain, but those with job strain extended
their sleep duration on non-­working days more than those without
job strain, the sleep extensions being 1 h 4 min (95% CI 53 min -­1 h
14 min) and 53 min (95% CI 47 min -­59 min), respectively.
Conclusions: Catch-­up sleep on non-­working days is a common phe-
nomenon among older employees in Finland. It remains unclear why
some employees engage in non-­working day catch-­up sleep while
others do not but experiencing high job strain might be one explana-
tion for catch-­up sleep.
Disclosure: The research is funded by Academy of Finland,
Finnish Ministry of Education and Culture, and the Finnish Work
Environment Fund. Authors declare no conflicts of interest.
P346 | Daytime sleepiness prevalence and its
association with psychosocial problems in Russian
urban adolescents: a school-­based study with
age-­corrected Pediatric Daytime Sleepiness Scale
cut-­offs
S. Tereshchenko; M. Shubina; N. Gorbacheva
Scientific Research Institute of Medical Problems of the North,
Krasnoyarsk, Russian Federation
Objectives/Introduction: Excessive daytime sleepiness (EDS) is one
of the most common sleep disorders in adolescents associated with
ABSTRACTS
social behaviors patterns and school performance. The Strengths
and Difficulties Questionnaire (SDQ) was developed by R. Goodman
[1] as a brief psychopathological screening tool that has been recom-
mended for the detection and classification of psychosocial problems
in adolescents. Data regarding the EDS prevalence and its associa-
tion with psychosocial problems in Russian adolescents are limited.
Methods: 4693 urban Siberian (Krasnoyarsk, Abakan, Kysyl) school-­
based adolescents (aged 12–18; boys/girl ratio 2190/2503) were
tested with self-­report version of SDQ questionnaire and Pediatric
Daytime Sleepiness Scale (PDSS [2]); cutoffs for EDS were PDSS
95% percentiles for each age group (12 y.o. -­20 points, 13 y.o. -­21
points, 14–16 y.o. -­22 points, 17–18 y.o. -­23 points), as it was pro-
posed [3]. Chi-­square and Kruskal-­Wallis tests were used.
Results: The overall prevalence EDS was 2.7% and was slightly higher
among girls (3.4%) compared to boys (2.1%, p = 0.005) and among
older (aged 15–18, 3.3%) compared to younger (aged 12–14, 2.2%,
p = 0.023) adolescents. Significant positive association was detected
between SDQ and PDSS scores (Kruskal-­Wallis test < 0.001).
Conclusions: The prevalence of EDS in Central Siberia urban adoles-
cents is 2.7% according to 95% percentiles age-­corrected cut-­offs.
EDS is closely associated with adolescence psychosocial problems.
References:
1. Goodman R. Psychometric properties of the strengths and dif-
ficulties questionnaire. J Am Acad Child Adolesc Psychiatry 2001;
40(11): 1337–45.
2. Drake C. et al. The pediatric daytime sleepiness scale (PDSS):
sleep habits and school outcomes in middleschool children. SLEEP
2003;26(4):455–458.
3. Brockmann PE et al. Influence of age and gender on refer-
ence values for common pediatric sleep questionnaires: Results
from a community-­based study. International Journal of Pediatric
Otorhinolaryngology 2018; 109: 127–32.
Disclosure: Nothing to disclose.
P347 | Influence of chronic radiofrequency
electromagnetic fields exposure on autonomic
nervous activity during sleep in preterm
neonates: preliminary Results
1 1 1
D. Besset ; B. Selmaoui ; S. Delanaud ; R. de Seze ; A. 1 Psychology, Ben Gurion University of the Negev, Be'er Sheva, Israel
Léké1,2; E. Stéphan-Blanchard1
1
PériTox Lab, University of Picardie Jules Verne; 2Neonatal Intensive
Care Unit, University Medical Center Amiens Picardie, Amiens, France
Objectives/Introduction: Autonomic nervous control during sleep
play a key role in the maintenance of homeostasis in preterm ne-
onates. Low-­
frequency electromagnetic (0–100 kHz) fields have
been associated with alteration in such mechanisms. However, it
has never been tested with high frequencies whereas preterm neo-
nates are also chronically exposed to radiofrequencies (RF, 87.5 MHz
-­5.8 GHz) while hospitalized. We investigated the influence of
|
      239 of 356
chronic RF exposure on autonomic nervous activity in sleeping pre-
term neonates.
Methods: Individual, continuous measurements of RF levels were
performed on 24 preterm neonates (gestational age: 29 ± 2 wk, birth
weight: 1277 ± 353 g) during the first 3 weeks after birth. Individual
RF exposure level over the whole recording period was expressed
as the median and the 99.9th percentile (P99.9, 0.1% of the highest
values). An overnight polysomnography including an ECG (sam-
pled at 2048 Hz) was performed on the last day of measurements.
Autonomic nervous activity was assessed through analysis of heart
rate variability with conventional time-­(mean heart rate, SDNN, r-­
MSSD) and frequency-­domain parameters (absolute, relative and
normalized powers in the low-­(LF) and high-­frequency (HF) bands,
LF/HF ratio). Linear relationships were computed between RF expo-
sure levels and HRV parameters according to rapid eye movement
(REM) and non-­REM (NREM) sleep stages.
Results: Results strongly depend on the sleep stage and RF expo-
sure level. The mean exposure values for the median and P99.9
were 0.02 ± 0.01 and 0.65 ± 0.25 respectively. At a median level,
increase in RF exposure was associated with a decrease in long-­term
variability during REM sleep only (normalized LF power: r²=0.258,
p = 0.0113). At high levels, increase in RF exposure was associated
with a decrease in short-­term variability during REM only(r-­MSSD:
r²=0.188, p = 0.0343 and absolute HF power: r²=0.179, p = 0.0393).
Conclusions: Taken as a whole, our results point out an overall de-
crease in autonomic nervous activity during REM sleep with low
chronic RF exposure in preterm neonates. The precise alterations
may depend on exposure levels and sleep stages. These findings
raise the question of the repercussions of these autonomic nervous
system disturbances on the child´s neurobehavioral and physiologi-
cal outcomes.
Disclosure: Nothing to disclose.
P348 | Sleep ecology and sleep patterns among
infants and toddlers: a cross-­cultural comparison
between the Arab and Jewish societies in Israel
G. Zreik1; L. Tikotzky2; K. Asraf1; I. Haimov1
1
Psychology, The Max Stern Yezreel Valley College, Emek Yezreel;
2
Objectives/Introduction: The purpose of this study was to examine
differences in reported sleep patterns (e.g., sleep onset, nocturnal
sleep duration, nocturnal wakefulness) and aspects of sleep ecol-
ogy (e.g., sleeping arrangements) in a sample of young children (from
birth to three years) between two major cultural groups in Israel:
Arab and Jewish.
Methods: Mothers of 497 healthy, typically developing infants and
toddlers (223 boys), ranging in age from 3 to 36 months (17.55 ± 9.49),
participated in the study; 253 of the mothers were Arab and 244
were Jewish. The mothers were asked to complete a questionnaire
 |
240 of 356       ABSTRACTS
about their child`s sleep (the Brief Infant Sleep Questionnaire) in ad-
dition to a demographic questionnaire.
Results: Arab children went to bed significantly later than Jewish
children, 2 hours later in the 3-­to 18-­month age group and approx-
imately an hour later in the 19-­to 36-­month age group, resulting
in shorter overall night duration, F(1,289) = 98.87, p <  0.001, par-
tial η2 = 0.25. Moreover, Arab children had longer sleep latency,
F(1,279) = 9.54, p < 0.001, partial η2 = 0.03, as well as longer noctur-
nal wakefulness, F(1,228) = 45.4, p < 0.001, partial η2 = 0.16. No dif-
ferences were found for daytime sleep. Furthermore, Arab mothers
perceived their infants’ sleep as more problematic than did Jewish
mothers, F(1,228) = 8.73, p < 0.001, partial η2 = 0.02. While room-­
sharing (infant sleeping in the parents´ room in a separate bed) was
the most common sleep arrangement among Arab families (77.6%
vs. 45.1% among Jewish families), infant sleeping in a separate room
was more common among Jewish families (46.3% vs. 9.7% among
Arab families). As toddlers, only 35.3% of Arab children slept in a
separate room, as compared to 70.9% of Jewish children. In addition,
more Jewish children fell asleep independently in their cribs than
Arab children, who were more likely to fall asleep in their cribs with
parental assistance.
Conclusions: A thorough understanding of sleep characteristics in
different cultures is crucial to our knowledge of infant sleep devel-
opment and will enable us to make our professional guidance and
interventions more attuned to the specific cultural context.
Disclosure: Nothing to disclose.
P349 | Effects of an online CBT-­I treatment
for pediatric sleep problems on emotion
dysregulation in young children: findings from
the web-­based sleep intervention program Mini-­
KiSS online
F. Lollies1; I. Brandhorst2; A.A. Schlarb3
1 2
Bielefeld University, Bielefeld; Tübingen University, Tübingen;
3
Psychology | Clinical Psychology and Intervention, Bielefeld University,
Bielefeld, Germany
Objectives/Introduction: Pediatric sleep problems are strongly
linked to future emotional problems. However, research regarding
the effect of CBT-­I intervention in early childhood on the outcome of
emotion dysregulation is missing. In order to fill this gap, the overall
objective of the current study was to investigate the effect of an
online cognitive behavioral treatment for pediatric sleep problems
(OCBT-­I) ‘Mini-­KiSS’ on emotion dysregulation in a population of
toddlers. 200 children (47% female) aged 7 to 63 months (M = 23.13)
suffering from behavioral sleep disturbances participated in the
Mini-­KiSS 6-­week online treatment.
Methods: A pre-­post-­follow-­up design was employed. Sleep prob-
lems were stated according to ICSD-­
3 and DSM-­
5 criteria and
emotional dysregulation was assessed with an emotion dysregula-
tion profile for children. Change scores were calculated, a repeated-­
measures ANOVA, and stepwise multiple linear regression was
performed.
Results: Directly after CBT-­I intervention for young children, emo-
tion dysregulation significantly declined (p = 0.000). Age was associ-
ated with the change in emotion dysregulation (p = 0.017). Gender
or the type of sleep disturbance did not have statistically significant
impact on change in emotion dysregulation (p =  ≥ 0.05). Clinically
significant improvement of emotional dysregulation was achieved in
14.5% of the children from pre-­to post-­measurement, and 25.3%
percent improved at follow-­up.
Conclusions: The findings show that treatment of pediatric sleep dis-
turbances reduce emotion dysregulation within an infant and toddler
population. Therefore, early sleep intervention might prevent men-
tal disorder in young children. In future, an extended longitudinal
design is needed to examine the preventing power of early-­improved
sleep on later psychopathological disorders. Beyond, future studies
should examine underlying mechanisms in more detail.
Disclosure: Nothing to disclose.
P350 | The mediating role of sleep in the
relationship between childhood trauma and
dissociation
A.S.-Y. Ng; W.-S. Chan
Psychology, The University of Hong Kong, Hong Kong, Hong Kong
Objectives/Introduction: Given the dreamlike characteristics of
dissociation, sleep has been suggested to play a role in the patho-
genesis of dissociation. Correlational and experimental studies sug-
gest that unusual sleep experience (e.g., hypnagogic hallucination)
and sleep deprivation are associated with dissociation (e.g., van
Heugten-­van der Kloet et al., 2015). Meanwhile, trauma is a robust
risk factor of dissociation, and a cause of acute sleep disturbances;
however, its long-­term impact on sleep is unclear. Few studies have
examined how childhood trauma, sleep, and dissociation interact,
especially if, abnormality in sleep would mediate dissociation devel-
opment. This study examined the mediating role of sleep between
childhood trauma and dissociation, and if the mediating effect dif-
fers between low betrayal trauma (LBT) (i.e., accident, disaster and
interpersonal trauma committed by non-­significant others) and high
betrayal trauma (HBT) (i.e., interpersonal trauma committed by sig-
nificant others).
Methods: Participants were 942 adults (72% female; mean
age = 27.34, SD = 9.29), who could read traditional Chinese.
Community dwelling participants filled out an online survey about
their sleep quality, unusual sleep experience, trauma history, disso-
ciative symptoms, psychological distress, and chronotype. Statistical
analyses were conducted using PROCESS macro for SPSS.
ABSTRACTS
Results: Thirty-­eight percent participants reported having at least
one type of childhood trauma. The most common type of LBT
was sexual assault (N = 47) while that of HBT was physical abuse
(N = 226). Bootstrapping analyses revealed that, after controlling for
age and gender, both unusual sleep experience (standardized indirect
effect = 0.08, 95% CI [0.06, 0.11]) and sleep quality (standardized in-
direct effect = 0.04, 95% CI [0.02, 0.06])) mediate the effect of child-
hood trauma on dissociation, but chronotype did not (standardized
indirect effect = 0.04, 95% CI [−0.02, 0.12]). However, only unusual
sleep experience remained a significant mediator after controlling
for psychological distress. Complete mediation was observed in both
LBT (partially standardized indirect effect = 0.07, 95% CI [0.03, 0.12])
and HBT (partially standardized indirect effect = 0.06, 95% CI [0.03,
0.10]), with small to medium effect.
Conclusions: Unusual sleep experience, but not sleep quality or
chronotype, mediated the impact of trauma on dissociation. This
finding is novel and suggests that sleep may be responsible for the
development of dissociation and that sleep intervention may pre-
vent and reduce dissociative symptoms among survivors of child-
hood trauma.
Disclosure: Nothing to disclose.
P351 | Validation of the Armenian version of
the Pittsburgh sleep quality index
H. Hovakimyan; M. Isayan; S. Khachatryan
Somnus Neurology Clinic, Yerevan, Armenia
Objectives/Introduction: Sleep disorders (SD) are common world-
wide. Insomnia and other SDs can cause serious health issues and
result from other disorders. They negatively impact sleep quality
(SQ). Hence, the importance of assessing SQ among patients and
the general population is high. Polysomnography (PSG) is not al-
ways available for economical and time management reasons. The
self-­administered Pittsburgh Sleep Quality Index (PSQI) is one of
the most frequently used scales, assessing subjective SQ during the
preceding month. It is easy to use and gives a relatively complete
overview of SQ. The current study aimed to validate the PSQI for the
Armenian-­speaking population.
Methods: The Armenian version of PSQI (PSQI-­Arm) was created
through stages of double forward-­and back-­translations by sepa-
rate pairs of bilingual professionals. The test stage was conducted
among Armenian-­speaking general and sleep clinic population sub-
jects. Within 4–14 days’ interval they underwent the retest. The final
version of the PSQI-­Arm was administered to patients at a tertiary
sleep center. Correlation analysis with some PSG variables and the
Armenian version of SF-­36 health-­related quality of life (HRQOL)
questionnaire was performed. The latter has eight domains as-
sessing physical, emotional, and overall HRQOL. Spearman´s and
Pearson´s tests were used.
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Results: An overall reliability coefficient (Cronbach´s alpha) of the
PSQI-­
Arm seven components was 0.8, suggesting high internal
consistency in a sample of 50 subjects, mean age-­33 years (18–74),
F-­
56%. High test-­
retest reliability was seen through correlation
analysis of components (r = 0.614–0.819, p < 0.01). Another group
of 203 patients (mean age-­38.3 years (18–81), F-­47.3%) completed
the PSQI-­Arm and SF-­36, and 54 of them underwent PSG. We saw
strong and significant (p < 0.001) negative correlations with all eight
SF-­36 domains (r coefficient from −0.288 to −0.517). We found
strong correlations with important PSG variables. Specifically, posi-
tive correlations between the PSQI-­Arm total score and wake time
(r = 0.43), number of awakenings (r = 0.35), and wake percentage
(r = 0.38); negative correlations were seen with sleep efficiency
(r = −0.38), AHI (r = −0.3), ODI (r = −0.28) (p < 0.05).
Conclusions: Our study results suggest that the Armenian version of
PSQI is a valid tool for assessing subjective SQ in Armenian popula-
tion with sleep complaints and shows high internal consistency and
reliability.
Disclosure: Nothing to disclose.
P352 | Validation of the Armenian version of
the Berlin questionnaire
H. Hovakimyan1; M. Isayan1; S. Khachatryan1,2
1
Somnus Neurology Clinic, 2Neurology and Neurosurgery, National
Institute of Health, Yerevan, Armenia
Objectives/Introduction: Obstructive sleep apnea (OSA) is a com-
mon sleep disorder that can ruin total sleep quality and efficiency,
cause serious health problems. Due to its high prevalence especially
among males, reliable screening tools are of high importance for clin-
ical practice. The Berlin Questionnaire (BQ) is a self-­administered
sleep apnea screening instrument. The responses are grouped into
three categories, and their overall score serves for evaluation of
sleep apnea risk. We aimed to validate the Armenian version of BQ
(BQ-­Arm).
Methods: We performed a cultural adaptation of the BQ-­
Arm.
Stages of double forward-­and back-­translations by different bilin-
gual professionals were conducted. The comparison of original BQ
and back-­translation results were satisfying. Pilot testing was imple-
mented to evaluate cultural barriers. No cultural adaptation difficul-
ties were noticed. Test-­retest procedure was conducted as the next
step. The same group of individuals with and without sleep com-
plaints filled the questionnaire twice: during the first visit and sec-
ond time within 4–14 days after the first time. Validation stage was
conducted among individuals with OSA suspicion. Correlation with
validated Armenian version of the Epworth Sleepiness Scale (ESS-­
Arm) and some PSG variables was performed by using Spearman´s
correlation analysis.
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242 of 356       ABSTRACTS
Results: We found high internal consistency (Cronbach´s alpha = 0.9)
and test-­retest reliability in a sample of 88 subjects, mean age -­
37.8 years (18–74), F-­48.9%: test-­retest correlation
analysis (r = 0.604–0.93, p < 0.01). Overall, 142 patients (mean age-­
40.3 years (18–81), F-­45.8%) completed the BQ-­Arm and the ESS-­
Arm. All participants underwent PSG. We saw strong and significant
(p < 0.001) positive correlations between BQ-­Arm total score and
body mass index (r = 0.6), apnea-­hypopnea index (r = 0.6), oxygen
desaturation index (r = 0.6), arousal index (r = 0.53), and signifi-
cant negative correlation with average oxygen saturation (r = −0.6)
(p < 0.01). Also, we found a significant positive correlation between
the BQ-­Arm and the ESS-­Arm total score (r = 0.55, p < 0.05). We
found significant similar correlations in the exclusively OSA group
(r = 0.48–0.5, p < 0.05).
Conclusions: Our study suggests that the Armenian version of the
Berlin Questionnaire is a valid and reliable instrument for assessing
OSA risk among Armenian-­speaking patients.
Disclosure: Nothing to disclose.
P353 | Reciprocal associations between
sleep, mental strain and training load in junior
endurance athletes, and the role of poor
subjective sleep quality
M. Hrozanova1; C.A. Klöckner1; Ø. Sandbakk1; S. Pallesen2,3;
F. Moen1
1 Alexandra Hospital, Athens, Greece; 2School of Health and Caring
Norwegian University of Science and Technology, Trondheim;
2 Sciences, University of West Attica, Athens, Greece, Athens;
University of Bergen; 3Norwegian Competence Center for Sleep
Disorders, Bergen, Norway
Objectives/Introduction: The importance of adequate sleep for ath-
letic functioning is well-­established. Still, literature shows that many
athletes report sleep of sub-­optimal quality or quantity. The influ-
ence of bidirectional variations in mental and physiological states on
sleep remains unknown. The present study therefore investigated
reciprocal associations between sleep, mental strain and training
load in athletes.
Methods: Prospective, observational design was utilized to follow
56 junior endurance athletes over 61 consecutive days. Unobtrusive,
objective measurements of sleep with novel radar technology were
obtained (Toften et al, 2020), and subjective daily reports of mental
strain and training load were collected. Subjective sleep quality was
measured with Pittsburgh Sleep Quality Index. Multilevel modeling
in Mplus was used to investigate the within and between-­level re-
ciprocal relationships between sleep, mental strain and training load.
Moderating effects of subjective sleep quality were used to identify
whether the said reciprocal associations depended on being a good
vs. a poor sleeper.
Results: Increases in mental strain were associated with decreased
total sleep time (TST, p =  0.001) and decreased sleep efficiency
(p =  0.005). Further, both mental strain and training load were
associated with decreased rapid eye movement (REM, respectively
p = 0.002 and p = 0.007) sleep. Increases in TST, light, deep and REM
sleep were all associated with decreases in subsequent training load
(respectively p <  0.001; p =  0.028; p =  0.006; p =  0.023). Finally,
among poor sleepers, increases in sleep onset latency were associ-
ated with increases in subsequent mental strain (p < 0.001), and in-
creases in deep sleep were associated with decreases in subsequent
training load (p = 0.002).
Conclusions: These results offer novel insight into the bidirec-
tional associations between sleep, mental strain and training load
in athletes, and demonstrate detrimental effects of mental strain on
sleep which is likely caused by mental activation incompatible with
sleep. An increased need for recovery, suggested by increased TST
and time in different sleep stages, was associated with subsequent
self-­regulatory reduction of training loads by the athletes. In poor
sleepers, increases in deep sleep may suggest an elevated need for
physiological recovery.
Disclosure: Nothing to disclose.
P355 | Sleep during ‘lockdown’ in COVID 19
pandemic
A. Trakada1; P. Pantelis T. Nikolaidisb2; N.-T. Economou1; P.
Steiropoulos3; B. Knechtle 4; G. Trakada1
1
Division of Pulmonology, Department of Clinical Therapeutics,
National and Kapodistrian University of Athens School of Medicine,
3
Department of Pulmonology, Democritus University of Thrace Medical
School, University Hospital of Alexandroupolis, Alexandroupolis,
Greece; 4Institute of Primary Care, University of Zurich, Zurich,
Switzerland, Zurich, Switzerland
Objectives/Introduction: As COVID-­19 spread rapidly to more than
100 countries around the globe, the World Health Organization
declared the novel coronavirus a pandemic. A third of the global
population was put on various forms ‘lockdown’, from national quar-
antines to school closures, in order to limit the number of cases and
slow down the spread of the virus. We conducted this study to de-
termine if this novel and stressful situation affected sleep quality in
general population and in health professionals.
Methods: We used a web-­based survey to screen 1765 men and
women with a short questionnaire of thirteen (13) questions which
was simultaneously distributed in three languages (Greek, German,
and French).
Results: A total of 1611 participants, with mean age 42.7 ± 12.8 years,
were considered for further analysis. A main effect of the ‘lockdown’
week on sleep duration was observed (p < 0.001, η2 = 0.011), with
the total sleep time of the actual week being longer than that under
normal conditions. A week*occupation interaction on the sleep dura-
tion was shown (p = 0.004, η2 = 0.005) and a pair-­wise t-­test showed
ABSTRACTS
that sleep length increased in the actual week in other occupations
by 0.42 ± 1.62 h (95% confidence intervals, CI, 0.33, 0.51; p < 0.001),
whereas it remained stable in health professionals (0.07 ± 1.48 h;
95% CI −0.13, 0.27; p = 0.496). Seven hundred ninety two (792) re-
sponders (49.2%) characterized their sleep during the actual week as
good -­51.2% of the general population, but only 38% of the health
professionals. Moreover, 300 responders (19.2%) reported even bet-
ter sleep this week than the previous, 50.3% of the general popula-
tion and 43.7% of the health professionals.
Conclusions: Sleep duration increased by 25.2 min per day in the
general population, but not in health professionals during COVID-­19
pandemic and quarantine.
Disclosure: Nothing to disclose.
P356 | Impact of evening smartphone use and
emotion regulation on circadian rhythm and sleep
S.R. Schmid; C. Hoehn; C. Plamberger; K. Bothe; M. Angerer;
K. Hoedlmoser
University of Salzburg, Laboratory for Sleep, Cognition and
Consciousness Research, Salzburg, Austria
Objectives/Introduction: Human sleep is highly vulnerable to in-
ternal (e.g., anxiety, affectivity) and external (e.g., light) influences.
There is growing evidence that the increasing usage of smartphones
-­especially in the evening and during bedtime -­influences the circa-
dian oscillator resulting in thermoregulatory and melatonin changes
by their short-­wavelength-­light emitting LED-­screens. Additionally,
previous findings assume that problems in emotion regulation (ER)
relate to lower sleep spindle density. However, results are rare re-
garding concurrent influences of ER and smartphone use on sleep.
Methods: 14 healthy male subjects (mean age: 21.93 ± 2.17) par-
ticipated in a within-­subjects design investigating the course of body
temperature (distal-­proximal skin temperature gradient; DPG) and
subjective sleepiness during three experimental conditions: Reading
1.5 hours (i) in a printed book (ambient light: 4.5lux), (ii) on a smart-
phone with (spectral peak: 613 nm, illuminance: 3032K), or (iii) with-
out blue-­
light-­
filter (spectral peak: 448 nm, illuminance: 8928K).
Polysomnographic data during sleep (NREM slow [11–13  Hz] and
fast [13–15  Hz] sleep spindle density at frontal and centroparietal
derivations) was recorded. Emotion regulation was assessed by
questionnaires measuring trait and state anxiety as well as positive
(PA) and negative affectivity (NA).
Results: Average DPG was higher between 2.45am and 3.15am
(p = 0.021) as well as between 3.20am and 3.50am (p = 0.035) after
reading in a book compared to reading on a smartphone without
filter. Further, sleepiness after awakening was higher in the book
compared to both smartphone conditions (p <  0.05). Lower slow
sleep spindle density was by trend associated with higher trait anxi-
ety in all three nights (all p < 0.10). Moreover, higher PA predicted
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higher subjective sleep quality (p = 0.025). NA was higher after read-
ing in a book compared to reading on a smartphone without filter
(p = 0.020).
Conclusions: Our results emphasize circadian modulations based
on DPG-­changes due to evening smartphone use expressed in less
vasodilation during the night and less sleepiness in the morning,
probably indicating lower nightly melatonin secretion. Lower NA
after reading on a smartphone points towards mood boosting short-­
wavelength-­light effects. Furthermore, these results corroborate
previous findings by showing associations between anxiety and slow
sleep spindle density as well as between PA and sleep quality, indi-
cating ER effects on sleep physiology and quality.
Disclosure: Nothing to disclose.
P357 | Assessing objective sleep quality in
insomnia patients with an index based on age
norms
T.A. Thomas; F.E. Gümüsdagli; R. Pietrowsky
Department of Clinical Psychology, Heinrich-­Heine-­University,
Düsseldorf, Germany
Objectives/Introduction: Objective sleep quality is commonly
measured by objective sleep parameters. Sleep parameters underlie
ontogenetic differences and are eligible as confounders in patients-­
controls differences if not age-­
matched. To obtain age-­
adjusted
measures of objective sleep-­quality we integrated sleep parameters
(N1-­N3, REM, SE, SL, TST, WASO) into an index that compares each
sleep parameter to norm values by age and categorizes them on a
1–10 scale. Two different scores for positive and negative sleep pa-
rameters, their sum (total score) and their quotient (index) are com-
puted. These tools are used to detect differences in sleep quality
between insomnia patients and controls. A study to evaluate and
verify this index is reported here.
Methods: We reanalyzed sleep parameters of 47 insomnia patients
and 266 controls (data from Roizenblatt et al., 2015) in the first sam-
ple and 16 patients and 9 controls (data from Terzano et al., 2001;
Golderberger et al., 2000) in the second sample. The groups in the
first sample did not differ by age whereas the groups in the second
sample did.
Results: In the first sample insomnia patients showed significantly
reduced sleep quality as indicated by the positive score of the index,
t(311) = 2.08, p = 0.039, and in the second U  =  22.00, Z  =  −2.84,
p = 0.012. Sleep parameters differed only in the second sample.
The difference decreased when age was considered. This index was
more sensitive than comparing sleep parameters alone.
Conclusions: The norm-­
based index differed between insomnia
patients and controls in both samples. It revealed that differences
in objective sleep quality are not due to age but due to impaired
sleep in the patient group. The index might be a promising meas-
ure for overall objective sleep quality allowing inferences that are
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244 of 356       ABSTRACTS
not confounded by age. In order to achieve an economic index
computation an R-­package and an SPSS syntax are currently under
development.
Disclosure: The authors declare that there is no conflict of inter-
est regarding the submitted work. The authors received no specific
funding for this work.
P358 | Daytime sleep features of habitual and
non-­habitual nappers
D. Bergamo1,2; A. Berardi1; S. Buonopane1; A. Mirabella1; S.
Corvi1; A. Visalli1,3; N. Cellini1,4,5
1
Department of General Psychology, Università degli Studi di Padova,
Padova; 2MOMILAB Research Unit, IMT School for Advanced Studies
3 4
Lucca, Lucca; Department of Neurosciences; Department of
Biomedical Sciences; 5Padova Neuroscience Center, Università degli
Studi di Padova, Padova, Italy
Objectives/Introduction: Midday naps seem to be beneficial for
mood, alertness, and performance. These effects appear more pro-
nounced in people who are used to take naps during the week, called
habitual nappers. Despite controversial results, habitual nappers
show different nap sleep architecture compared to non-­habitual
nappers (e.g., lighter sleep). Here, we further investigated the elec-
trophysiological sleep features of the nap in habitual (HN) and non-­
habitual nappers (NHN).
Methods: Twenty-­six subjects (F = 13, mean age = 24,3) took a day-
time nap in the laboratory. Before and after the nap they completed
sleepiness and mood questionnaires and performed a recall memory
task on facts learning. Their sleep was polysomnographically-­recorded
and scored according to standard criteria. Power spectral analysis was
performed on free of artifacts epochs using FFT techniques. The sub-
jects were divided into HN (2 + naps/week) and NHN (< 2 naps/week)
depending on the number of weekly naps reported in their sleep diary.
Results: The groups did not differ on subjective sleepiness, sleep effi-
ciency, or sleep macrostructure. NHB showed a higher slow oscillation
power density (p = 0.036) over frontal sites. Differences between the
two groups were also detected in sleep spindles events, especially fast
spindles (FS). FS density over parietal electrodes (p = 0.03), and FS du-
ration (p = 0.003) and intensity (p = 0.015) over central electrodes were
significantly higher in habitual than non-­habitual nappers even after
FDR correction for multiple comparisons. However, greater FS activ-
ity did not predict memory performance (post minus pre nap scores),
which was similar between the two groups.
Conclusions: Our results indicate that nap practice does not in-
fluence perceived sleepiness and nap architecture, although HN
showed a lighter sleep (lower slow oscillation activity) than NHN.
At a more fine-­graded analysis, however, these data confirmed the
evidence of a footprint of nap practice on naps micro-­structure, es-
pecially regarding fast spindles. However, this effect did not show to
be as strong as expected. In addition, FS enhancement do not cor-
relate with memory performance.
Disclosure: Nothing to disclose.
P359 | Effect of sleep on metabolic health
G. Zhu1; M. Catt2; K. Anderson3; D. Gunn4; M.
Birch-Machin1
1
Newcastle University; 2National Innovation Centre for Ageing; 3Royal
Victoria Infirmary, Newcastle upon Tyne; 4Unilever R&D, Colworth
Science Park, United Kingdom
Objectives/Introduction: Sleep is essential for various functions
such as brain processing, energy conservation and memory con-
solidation. The architecture of sleep changes during ageing. Sleep
restriction and sleep disorders are common in modern society. Poor
sleep has been identified as a major modifiable risk factor for meta-
bolic diseases and is also associated with cognitive impairment and
depression.
Methods: A cross-­sectional analysis was carried out on data from
the UK Biobank (n = 84411). Participants were aged between
43–79 years, and sleep parameters were objectively measured
using wrist-­worn accelerometers. Sociodemographic, health-­related
and lifestyle information were collected using questionnaires.
Participants were divided into five groups depending on their sleep
duration. Short sleepers: (1) < 5 hours/night, (2) 5–6 hours/night, (3)
6–7 hours/night; normal sleepers: (4) 7–8 hours/night; long sleepers:
(5) > 8 hours/night.
Results: Males, older people and those with lower social status were
more likely to be short sleepers (p < 0.05). The percentage of par-
ticipants with metabolic diseases including cardiovascular disease,
diabetes and hypertension was significantly lower in those who slept
between 6–8 hours/night compared to both short and long sleep-
ers (p < 0.05). Those who slept 6–7 hours had the fastest reaction
time (p < 0.001). Short sleepers were more likely to experience mood
swings, loneliness and risk taking behaviours (p < 0.05). They were
also less satisfied in general and regarding their health (p < 0.05).
Conclusions: Sleep duration between 6–8 hours/night was associ-
ated with better metabolic health and cognitive function. Short
sleepers were more likely to experience abnormal mood. However,
no causal link can be established from this study. These results can
help to develop interventions for targeted groups to reduce the ad-
verse effects of poor sleep. Additionally, a sleep study is currently
being conducted to investigate the differences in subjective and ob-
jective assessments of sleep in healthy controls and patients with
sleep disorders (n = 50).
Disclosure: Nothing to disclose.
ABSTRACTS
P360 | Adolescents’ lived experience of
sleeping difficulties
M. Jakobsson1; K. Högberg1; K. Sundin2; K. Josefsson1,3
1
Department of Caring Science, University of Borås, Borås;
2
Department of Nursing, Umeå University, Umeå; 3Department of
Health Science, Karlstad University, Karlstad, Sweden
Objectives/Introduction: Sleeping difficulties, including insufficient
sleep, trouble falling asleep, waking up at night, or sleep that does not
leave an individual rested, are increasingly prevalent among adoles-
cents and have negative consequences for their’ health, well-­being, and
education. It is of utmost importance to research adolescents’ sleep. A
range of studies with different methodological perspectives are needed
to inform and understand adolescents’ sleep. To date, there are few
studies in sleep research that take a qualitative approach. Therefore, it
is important to illuminate adolescents’ own experience of sleeping dif-
ficulties to acquire broader knowledge and the necessary evidence in
order to provide preventive care interventions.
Methods: The data were obtained from narrative interviews with 16
adolescents aged 14–15 in a Swedish city and were analyzed using
the phenomenological hermeneutic method.
Results: Four themes that illustrate the meaning of adolescents
experience of sleeping difficulties emerged: feeling dejected when
not falling asleep, experiencing the night as a struggle, searching for
better sleep, and being affected the next day. The comprehensive
understanding illuminates what being an adolescent with sleeping
difficulties means; it is a challenge to go through the night; cope with
the next day; and to harbor a panorama of emotions that emerge
during the night, such as frustration, annoyance, concern, dejection,
sadness, and fear. These emotions arise when the adolescent is un-
able to unwind and has concerns that grow during the night. The
adolescent experience a feeling of being trapped in circumstances,
all of which are incompatible with getting a good night's sleep.
Conclusions: In order to understand adolescents’ sleeping difficul-
ties, a comprehensive understanding of the context in which the
adolescents live is needed. Adolescents need to navigate and find
balance in relation to circumstances that may affect their sleep and
that are often beyond their control, such as norms and values in so-
ciety, in social media, in school, and in family and friend groups. By
genuinely listening to the adolescents’ narratives about their sleeping
difficulties and the context in which they interact will parents, pro-
fessional caregivers, and researchers increase their understanding.
Disclosure: Nothing to disclose.
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P361 | Association between REM sleep
microarchitecture and grey matter in the
hippocampus and entorhinal cortex of late
middle-­aged and older adults with obstructive
sleep apnea
M.-E. Martineau-Dussault1,2; A.-A. Baril3; H. Blais1; D. Petit1;
K. Gagnon1,4; J. Legault1,2; A. Lafrenière1,2; C. André5,6; D.
Gilbert1; J. Carrier1,2; N. Gosselin1,2
1
Center for Advanced Research in Sleep Medicine, Hôpital du Sacré-­
Coeur de Montréal; 2Department of Psychology, Université de
Montréal, Montreal, QC, Canada; 3The Framingham Heart Study,
Boston University School of Medicine, Boston, MA, United States;
4
Faculty of Medicine, Université de Montréal, Montreal, QC, Canada;
5
Physiopathology and Imaging of Neurological Disorders, Normandie
Univ, UNICAEN, INSERM, U 1237, Institut Blood and Brain; 6GIP
Cyceron, NIMH, Normandie Univ, UNICAEN, PSL Université, EPHE,
INSERM, U 1077, CHU, Caen, France
Objectives/Introduction: In REM sleep, the cholinergic system is
particularly active, while the activity of other neurotransmitter sys-
tems is significantly reduced. REM sleep, more specifically EEG theta
and alpha power, could be more sensitive than wakefulness or NREM
sleep to assess cholinergic degeneration processes in early demen-
tia. Yet, few studies have investigated the link between spectral ac-
tivity during REM sleep and cerebral atrophy in regions particularly
affected by Alzheimer's disease. Moreover, how obstructive sleep
apnea (OSA), a recently identified risk factors for dementia, and re-
lated REM sleep alterations affect this association is unknown. Here,
we explored whether hippocampal and entorhinal cortex structure
were related to spectral activity during REM sleep in late middle-­
aged and older adults with and without OSA.
Methods: Twenty-­
t wo non-­
treated OSA participants (apnea-­
hypopnea index [AHI] ≥ 15 events/h; mean age 65.4 ± 5.8 years; 3
women; 9 mild cognitive impairments [MCI] ) and 33 controls
(AHI < 15; mean age 62.9 ± 6.0; 6 women; 12 MCI) were included.
Participants were evaluated with overnight polysomnography and
magnetic resonance imaging. The absolute theta (4–8 Hz) and alpha
(8–13 Hz) power was computed for F3, C3, P3, O1, T3, T4, T5 and T6
during REM sleep. Using FreeSurfer, the hippocampal and entorhinal
volume, in addition to entorhinal thickness were extracted. Partial
correlations controlling for age and education were performed
between the EEG power and neuroimaging data in each group
separately.
Results: In the control group, significant positive correlations were
found between the left entorhinal cortex thickness and both theta
(r = 0.575–0.629; p < 0.001) and alpha
(r = 0.502–0.607; p < 0.003) activity for all electrodes during REM
sleep. No significant correlations were found in the OSA group.
Conclusions: These preliminary results suggest that a lower left en-
torhinal cortex thickness is associated to less EEG theta and alpha
power during REM sleep in late middle-­aged and older adults without
 |
246 of 356       ABSTRACTS
OSA, which could be linked to cholinergic degeneration processes.
However, this was not observed in the OSA group, which could sug-
gest that OSA mechanisms, such as hypoxia and sleep fragmenta-
tion, might confound this association.
Disclosure: Nothing to disclose.
P362 | Effects of short-­and long-­term
solriamfetol treatment on adherence to primary
obstructive sleep apnoea therapy
P.K. Schweitzer1; K.P. Strohl2; G. Mayer3,4; R. Rosenberg5,6;
P. Chandler7; M. Baladi7; L. Lee7; A. Malhotra8
1
Sleep Medicine and Research Center, St. Luke's Hospital, Chesterfield,
MO; 2Case Western Reserve University, Cleveland, OH, United
States; 3Hephata Klinik, Schwalmstadt, 4Philipps University, Marburg,
Germany; 5NeuroTrials Research, Inc.; 6Atlanta School of Sleep
Medicine, Atlanta, GA; 7Jazz Pharmaceuticals, Inc., Palo Alto; 8Division
of Pulmonary, Critical Care and Sleep Medicine, University of California
San Diego Medical Center, La Jolla, CA, United States
Objectives/Introduction: Solriamfetol, a dopamine/norepinephrine
reuptake inhibitor, is approved in the EU and US to treat excessive
daytime sleepiness (EDS) associated with obstructive sleep apnoea
(OSA; 37.5–150 mg/d). This analysis evaluated whether treatment
of EDS with solriamfetol affected primary OSA therapy device use.
Methods: Data from a 12-­week, randomised, double-­blind, placebo-­
controlled phase 3 trial (NCT02348606) and an open-­label exten-
sion (OLE) trial  ≤  52  weeks (NCT02348632) were analysed. Adult
participants received solriamfetol 37.5 (12-­
week study only), 75,
150, or 300 mg/d or placebo (12-­week study only). Inclusion re-
quired current/prior primary OSA therapy use, including positive air-
way pressure (PAP), oral appliance, or surgical intervention. Primary
OSA therapy use was recorded throughout the studies as electroni-
cally downloadable data (when available) or via diary. Baseline and
end-­of-­study data are summarised for the safety populations. OLE
data are reported for participants with OSA directly enrolled from a
previous study; baseline refers to baseline in the parent study.
Results: Primary OSA therapy use was reported for 344/474 partici-
pants in the 12-­week study (solriamfetol, n = 261; placebo, n = 83)
and 235/333 participants in the OLE. Of these, the majority were
utilising PAP (12-­week study, 318 [92%]; OLE, 222 [94%]). In the 12-­
week study, baseline mean therapy use was similar across treatment
groups, with use on 89%–90% nights/week, 6.6–6.7 hours/night,
and use ≥ 50%/night on 91%–93% of nights; OLE population base-
line values were 90% nights/week, 6.6 hours/night, and use ≥ 50%/
night on 90% of nights. In the 12-­week study, there was no mean-
ingful change in primary therapy use for participants on solriamfe-
tol or placebo: mean (SD) changes from baseline to endpoint were
1.1% (12.0%) and 0.8% (12.1%) nights/week, −0.3 (1.2) and −0.3 (0.9)
hours/night, and use ≥ 50%/night on 2.2% (13.7%) and 2.7% (19.4%)
of nights, respectively. OLE changes from baseline were 0.9%
(12.4%), −0.8 (1.7), and 6.5% (20.5%), respectively. Common adverse
events (≥5% in either study) with solriamfetol were headache, nau-
sea, decreased appetite, anxiety, nasopharyngitis, diarrhoea, dry
mouth, insomnia, and upper respiratory infection.
Conclusions: Treatment of EDS with solriamfetol did not affect pri-
mary OSA therapy use throughout the 12-­week or OLE study. Safety
was similar between studies.
Disclosure: PK Schweitzer has received research funding from Jazz
Pharmaceuticals, NightBalance, Apnimed, Avadel-­
Flamel, Balance
Therapeutics, Suven Life Sciences, and Harmony Biosciences. KP
Strohl has served as an advisory board member and is a principal in-
vestigator for Jazz; is a site principal investigator for Inspire Medical
Systems; and has received consultancy fees from Sommetrics, GSK
(Galvani Bioelectronics), and 7 Dreamers. G Mayer has received hon-
oraria from the Paul Ehrlich Institute, Germany; has served on the
speakers’ bureau for UCB Pharma and Sanofi; and is a board member
of the European Narcolepsy Network. R Rosenberg has received con-
sultancy fees from Eisai; honoraria from Merck; and research fund-
ing from Jazz Pharmaceuticals, Merck, Actelion, Eisai, and Philips
Respironics; and has served on the speakers’ bureau for Merck and as
a board member for Jazz Pharmaceuticals. P Chandler and M Baladi
are employees of Jazz Pharmaceuticals who, in the course of this
employment, have received stock options exercisable for, and other
stock awards of, ordinary shares of Jazz Pharmaceuticals plc. L Lee is
a former employee of Jazz Pharmaceuticals who, in the course of this
employment, received stock options exercisable for, and other stock
awards of, ordinary shares of Jazz Pharmaceuticals plc. A Malhotra
has served as a principal investigator for a Jazz study but receives no
outside personal income as a recent officer of the American Thoracic
Society; ResMed gave a philanthropic donation to the University of
California, San Diego, in support of a sleep center.
P364 | The return of the nap: daytime sleep
benefits procedural memory in older adults
B. Toor1; N. van den Berg1; L. Ray2; S. Fogel1,2,3
1
School of Psychology, University of Ottawa; 2The Royal's Institute
for Mental Health Research; 3Brain and Mind Research Institute,
University of Ottawa, Ottawa, ON, Canada
Objectives/Introduction: When faced with a new problem to solve,
the old adage to ‘sleep on it’ is good advice. Sleep is known to en-
hance insight to novel solutions to problems. As we age, both the
quantity and quality of sleep are drastically reduced, but naps re-
appear. Age-­related deficits in sleep-­dependent memory consolida-
tion have been recently identified. The scope of these deficits is not
known. Here, we investigated the impact of age-­related changes in
sleep on skills that require the acquisition of a novel cognitive strat-
egy (e.g., on the Tower of Hanoi; ToH).
Methods: 90 participants (N = 60 young, N = 30 older) were included
in the study. Young participants were assigned to either the: 1) Sleep
ABSTRACTS
Condition (N = 20) PM Trained, slept overnight and AM Retested;
2) Nap Condition (N = 20) AM Trained, had a 90 min nap; N = 20
young and PM Retested, or; 3) Wake Condition (N = 20) AM Trained,
remained awake and PM Retested. Older participants were assigned
to the Nap (N = 14) or Wake condition (N = 16). Participants com-
pleted 8 trials of the 5-­disk ToH at the Training Session and 4 trials
at Retest. The ToH is a procedural task that requires the acquisition
of a novel cognitive strategy (i.e., recursive logic) in order to improve
performance (e.g., %-­change in errors from Training to Retest).
Results: A Nap condition (Nap/Wake) x Age (Young/Older) 2x2
ANOVA revealed a significant interaction for %-­
change in errors
(F(1,66) = 5.42, p = 0.023). Follow-­up t-­tests showed older adults,
but not younger adults, improved after a nap, compared to wake
(t(28) = 2.39, p = 0.024). In addition, a one-­way ANOVA (Sleep/Nap/
Wake) in the Young revealed that the %-­change in errors differed as
a function of condition (F(2,57) = 3.40, p = 0.04). Follow-­up t-­tests
showed that sleep enhanced performance compared to both the Wake
(t(38) = 2.26, p = 0.03) and the Nap (t(38) = 2.57, p = 0.014) condition.
Conclusions: Overall, young adults benefit from a night of sleep,
but not from a daytime nap as compared to wake. By contrast, older
adults derive a benefit from a daytime nap as compared to wake.
This may suggest that cognitive abilities that are relatively preserved
with age may be supported by the reappearance of daytime napping
that occurs with age.
Disclosure: Nothing to disclose.
P365 | Associations between tau protein levels
and self-­reported sleep quality in older adults
with and without cognitive complaints
K. Habibi1; A.A. Perrault1,2; N.E. Cross1,2; A. Hadjinicolaou1;
Z. Duquette1; C.H. Bastien3; C. Hudon3; J.-F. Gagnon2,4,5;
R. Postuma6; J. Carrier2,5,7; N. Gosselin5,6; T.T. Dang Vu1,2,8;
Consortium for the Early Identification of Alzheimer's
Disease-Quebec (CIMA-Q)
1 P366 | Interictal epileptic activity disrupts
Department of Health, Kinesiology and Applied Physiology, Concordia
University, Sleep, Cognition and Neuroimaging Lab; 2Centre de
Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montreal;
3
Ecole de Psychologie, Université Laval, Québec; 4Dpt de Psychologie,
Université du Québec à Montréal; 5Centre d’Études Avancées en
Médecine du Sommeil, CIUSSS-­du-­Nord-­de-­l’île-­de-­Montréal; 6Dpt de
Psychologie; 7Département de Psychologie, Université de Montreal;
8
PERFORM Center, Concordia University, Montreal, QC, Canada
Objectives/Introduction: Hyperphosphorylation and intracellular
aggregation of tau protein is a key protagonist in Alzheimer's dis-
ease (AD) pathogenesis. Tau protein levels can be measured in the
cerebrospinal fluid (CSF) and constitute a biomarker of progression
from subjective cognitive decline (SCD) or mild cognitive impairment
(MCI) towards AD. Sleep disruption has been shown to increase the
risk of cognitive decline with age and enhance tau protein levels
|
      247 of 356
in the CSF of cognitively normal individuals. Here we investigated
the cross-­sectional association between tau protein levels and self-­
reported sleep measures in three groups, namely seniors with SCD,
MCI, or cognitively healthy participants (CTL).
Methods: Forty-­eight participants, including 12 CTL (71.6 ± 5 y.o; 7
females), 20 with SCD (73.5 ± 6.2 y.o; 12 females) and 16 with MCI
(74.1 ± 4.9 y.o; 8 females) were analysed from the Consortium for
the Early Identification of Alzheimer's Disease-­Quebec (CIMA-­Q )
cohort. CSF (10–15 mL) was obtained through lumbar puncture to
measure tau protein levels (ng/L). Self-­reported measures of sleep
quality included the insomnia severity index (ISI), sleep duration (SD)
and sleep efficiency (SE) over the past month using questionnaires.
Group effect on tau protein levels was tested with one-­way ANOVA.
Spearman's correlations, controlling for age, evaluated the associa-
tions between tau protein and sleep measures across and within
groups.
Results: CSF tau protein levels were not different between the
3 groups (F2,45 = 1.75, p = 0.19; CTL: 278.1 ± 117.2 ng/L; SCD:
280.4 ± 118.8 ng/L; MCI: 348.6 ± 125.6 ng/L). Tau levels were nega-
tively correlated with SD across the groups (rs=−0.36, p = 0.012*; SE:
rs=−0.24, p = 0.11; ISI: rs=0.20, p = 0.17). No significant correlations
were noted in the CTL group (SE: rs=0.08, p = 0.81; SD: rs=−0.21,
p = 0.52; ISI: rs=0.51, p = 0.11). Tau levels were negatively corre-
lated with SE in SCD (rs=−0.57, p = 0.0097**; SD: rs=−0.28, p = 0.23;
ISI: rs=0.20, p = 0.42), while in the MCI group, they were negatively
correlated with SD (rs=−0.52, p = 0.046*; SE: rs=0.07, p = 0.80; ISI:
rs=−0.03, p = 0.91).
Conclusions: These preliminary findings show that higher levels of
CSF tau protein are associated with lower self-­reported sleep qual-
ity in SCD and MCI, suggesting that poor sleep might be linked to
the neurodegenerative process underlying age-­related cognitive de-
cline. Future studies are needed to confirm these findings in larger
samples and longitudinal designs.
Disclosure: Nothing to disclose.
sleep: a combined stereo electroencephalography
and polysomnography study
L. Peter-Derex1,2,3; P. Klimes1,4; V. Latreille1; S. Bouhadoun1;
F. Dubeau5; B. Frauscher1,5
1
Analytical Neurophysiology Lab, Montreal Neurological Institute,
McGill University, Montreal, QC, Canada; 2Center for Sleep
Medicine and Respiratory Diseases, Lyon University Hospital; 3Lyon
Neuroscience Research Center, Lyon, France; 4Institute of Scientific
Instruments, The Czech Academy of Sciences, Brno, Czech Republic;
5
Epilepsy Unit, Montreal Neurological Institute, McGill University,
Montreal, QC, Canada
Objectives/Introduction: Disturbed sleep is common in people
with epilepsy. However, the direct influence of nocturnal interictal
 |
248 of 356       ABSTRACTS
epileptic activity (IEA) on sleep fragmentation remains poorly un-
derstood. The aim of this study was to investigate the relationship
between sleep-­related IEA and arousals.
Methods: Thirty-­
six patients with focal drug-­
resistant epilepsy
who underwent combined stereo-­
electroencephalography and
polysomnography recordings in the context of pre-­surgical epilepsy
evaluation were selected from the Montreal Neurological Institute
database between 01/2010 and 01/2020. We visually marked
sleep stages, arousals and epileptic bursts. Epileptic spikes were
detected automatically. The spike index and epileptic burst index
(n/sec/channel) were computed for four 3-­second time windows:
baseline sleep, pre-­arousal, arousal, and post-­arousal. Both indices
were compared across the four time windows. Sleep stage (N2, N3,
rapid-­eye-­movement sleep (R)) and anatomical localization (mesial
temporal versus neocortical) were tested as modulating factors of
nocturnal IEA fluctuations. Finally, we assessed the intra-­arousal dy-
namics of spikes and their relationship to the slow wave component
of arousals.
Results: A total of 3481 arousals (2518 in N2, 547 in N3 and 416
in R) were analyzed. Epileptic bursts significantly increased before
arousals, regardless of sleep stage or brain area, as compared to
baseline (p = 0.0005) and post-­arousal (p = 0.0001). Similar results
were obtained for the spike index (p = 0.01 and p = 0.04 respec-
tively), but with an additional significant increase at the time of the
arousal (p = 0.0039 and p = 0.003 respectively). A sleep stage effect
was found for spikes, as the increase observed before and during
arousals relative to baseline was only significant for N2 and R but not
N3 sleep. Moreover, while the increase in spikes before the arousal
was independent of the anatomical localization, the increase during
the arousal was only found in neocortical channels (p < 0.0001 ver-
sus both baseline and post-­arousal) where it was strongly correlated
to the slow wave component of the arousal (spike index delayed by
0.4s, r = 0.99, p < 0.0001).
Conclusions: The increase in epileptic bursts and spikes prior to
arousals suggests that IEA is involved in sleep disruption in epilepsy
patients. The additional increase in the spike rate during arousals
may result from a sleep-­wake boundary instability suggesting a bidi-
rectional relationship between both entities.
Disclosure: This authors have no conflicts of interest to de-
clare. This work was funded by start-­up funding of the Montreal
Neurological Institute and research project grants of the 2017/2018
competition of the Savoy Epilepsy Foundation to F.D and B.F. L.P-­
D. is supported by the Mircea Steriade scholarship of the Savoy
Epilepsy Foundation.V.L. is supported by a postdoctoral fellowship
of the Montreal Neurological Institute. B.F. is supported by a sal-
ary award (‘Chercheur‐boursier clinicien Junior 2’) of the Fonds de
Recherche du Québec -­Santé. P.K. is supported by The Molson
Neuroengineering fellowship of the Montreal Neurological Institute
and by INTER‐ACTION (LTAUSA18056).
P367 | Clinically relevant effects of
solriamfetol on excessive daytime sleepiness:
post hoc analyses of clinical trials in narcolepsy
or obstructive sleep apnoea
R. Rosenberg1; M. Baladi2; M. Bron2
1
NeuroTrials Research, Inc, Atlanta, GA; 2Jazz Pharmaceuticals, Palo
Alto, CA, United States
Objectives/Introduction: Solriamfetol, a dopamine/norepinephrine
reuptake inhibitor, is approved in the EU and US for excessive day-
time sleepiness (EDS) associated with narcolepsy (75–150 mg/day)
or obstructive sleep apnoea (OSA; 37.5–150 mg/day). In 12-­week
phase 3 studies, solriamfetol significantly reduced self-­reported EDS
in participants with narcolepsy or OSA. This post hoc analysis fur-
ther evaluated the clinical relevance of the effects of solriamfetol
on EDS.
Methods: In 12-­
week phase 3 studies (NCT02348593,
NCT02348606), adult participants with narcolepsy or OSA and
Epworth Sleepiness Scale (ESS) scores ≥ 10 were randomised to re-
ceive placebo or solriamfetol (37.5 [OSA only], 75, 150, or 300 mg).
Cumulative distribution function plots (modified intent-­to-­treat pop-
ulations; last-­
observation-­
carried-­
forward approach) were gener-
ated to estimate the percentage of participants with ESS score ≤ 10
(within normal range) and the percentage of participants with ≥ 25%
decrease from baseline in ESS score at Week 12.
Results: In participants with narcolepsy, baseline mean±SD ESS
scores were 17.3 ± 2.9 for placebo (n = 58) and 17.2 ± 3.3 for solriamfe-
tol (all doses; n = 173). At Week 12, 39.9% of participants randomised
to solriamfetol (all doses) reported ESS scores ≤ 10, compared with
15.5% of participants on placebo. Additionally, at Week 12, 51.4%
of participants who received solriamfetol (all doses) had ≥ 25% de-
crease from baseline in ESS scores compared with 27.6% of par-
ticipants on placebo. In participants with OSA, baseline mean±SD
ESS scores were 15.6 ± 3.3 for placebo (n = 114) and 15.1 ± 3.3 for
solriamfetol (all doses; n = 345). At Week 12, 65.8% of participants
randomised to solriamfetol (all doses) reported ESS scores  ≤  10,
compared with 37.7% on placebo. Additionally, at Week 12, 70.1%
of participants who received solriamfetol (all doses) had ≥ 25% de-
crease from baseline in ESS scores compared with 36.8% on placebo.
In both studies, the percentage of participants with ESS scores ≤ 10
increased with larger solriamfetol doses. Frequent adverse events
(≥5%) with solriamfetol were headache, nausea, decreased appetite,
nasopharyngitis, dry mouth, and anxiety.
Conclusions: Most participants on solriamfetol experienced clini-
cally meaningful improvements in EDS, with ~40% and ~66% of par-
ticipants with narcolepsy and OSA, respectively, achieving normal
ESS scores. Safety profiles were similar in narcolepsy and OSA.
Disclosure: R Rosenberg has received consultancy fees from Eisai;
honoraria from Merck; research funding from Jazz Pharmaceuticals,
Merck, Actelion, Eisai, and Philips Respironics; and has served on the
speakers’ bureau for Merck and as an advisory board member for Jazz
ABSTRACTS
Pharmaceuticals. M Baladi is an employee of Jazz Pharmaceuticals
who, in the course of this employment, has received stock op-
tions exercisable for, and other stock awards of, ordinary shares
of Jazz Pharmaceuticals plc. M Bron is a former employee of Jazz
Pharmaceuticals who, in the course of this employment, received
stock options exercisable for, and other stock awards of, ordinary
shares of Jazz Pharmaceuticals plc.
P368 | Subtle cognitive deficits are associated
with brain atrophy in isolated rem sleep behavior
disorder
M. Brillon-Corbeil1,2; S. Rahayel1,3; M. Gaubert1,2; R. B.
Postuma1,4; J. Montplaisir1,5; J. De Roy1,2; J. Carrier1,5,6; O.
Monchi7; J.-F. Gagnon1,2,8
1
Center for Advanced Research in Sleep Medicine, Recherche CIUSSS-­
NIM; 2Psychology, Université du Québec à Montréal; 3McGill
University; 4Neurology, Montreal General Hospital; 5Psychology,
Université de Montréal; 6Institut Universitaire de gériatrie de Montréal,
Montreal, QC; 7Clinical Neurosciences and Radiology, University of
8
Calgary, Calgary, AB; Centre de Recherche, Institut Universitaire de
Gériatrie de Montréal, Montreal, QC, Canada
Objectives/Introduction: Mild cognitive impairment (MCI) is found
in more than a third of patients with isolated REM sleep behavior
disorder (iRBD). These patients show more extensive cortical and
subcortical brain abnormalities. However, the neuroanatomical cor-
relates of subtler cognitive deficits remain unknown in this popu-
lation. This study aims to investigate the cortical and subcortical
correlates of subtle cognitive deficits in iRBD.
Methods: Thirty-­five iRBD patients, and 20 healthy controls (HC)
with normal cognition, were recruited. Patients were classified into
two groups based on their cognitive performance: nine patients with
normal cognition (iRBD-­NC) and 26 patients with subtle cognitive
deficits (iRBD-­SCD), as defined by an impaired performance on a
single cognitive test. T1-­weighted brain images were acquired from
all participants through 3T MRI. Between-­group differences in local
cortical thickness and subcortical shape were investigated using
vertex-­based surface analyses in SPM CAT12v6 and FSL-­FIRST, re-
spectively. Results were considered significant at p < 0.05 corrected
for family-­wise error with age, gender, and education as covariates.
Results: iRBD-­SCD patients had a more contracted subcortical sur-
face compared to iRBD-­NC patients (left putamen and thalamus) and
HC (bilateral putamen, left thalamus, pallidum, and hippocampus).
Moreover, iRBD-­SCD patients had bilateral areas of cortical thinning
in the frontal cortex (superior, middle, inferior, and orbito-­frontal
gyrus) compared to HC. Otherwise, iRBD-­NC patients had a more
contracted subcortical surface limited to left accumbens, pallidum,
and right caudate compared to HC.
|
      249 of 356
Conclusions: These preliminary results suggest that iRBD patients
who have subtle cognitive deficits also present with more pro-
nounced cortical and subcortical atrophy.
Disclosure: Dr. Postuma reports grants from Parkinson Canada,
Michael J. Fox Foundation, Webster Foundation, and personal
fees from Takeda, Roche/Prothena, Teva Neurosciences, Novartis
Canada, Biogen, Boehringer Ingelheim, Theranexus, GE HealthCare,
Jazz Pharmaceuticals, Abbvie, Jannsen, Otsuko, Phytopharmics,
Inception Sciences, not related to the submitted work. Dr. Carrier re-
ports grants from Canopy Health, Rana, Merck, Philips/Respironics,
and Canopy Growth/Spectrum, not related to the submitted work.
Dr. Gagnon reports grants from Canada Research Chair. All other
authors report no relevant conflicts of interest.
P369 | A gene first approach toward
understanding sleep disturbances in autism
R. Tesfaye1; G. Huguet2; M. Loum2; E. Douard2; M. Jean
Louis2; G. Rouleau1; S. Jacquemont2; M. Elsabbagh1
1
Neurology & Neurosurgery, Montreal Neurological Institute, McGill
University; 2University of Montréal Medicine, CHU Sainte-­Justine,
Montreal, QC, Canada
Objectives/Introduction: Sleep is disturbed in up to 80% of youth
with autism (ASD) and suggested to result from genetic abnormali-
ties that increase ASD risk, like copy number variants (CNVs; genomic
deletions or duplications). In addition to previously established cir-
cadian rhythm genes, recent genome wide association studies have
implicated over 900 genes with insomnia. We hypothesize that rare
variants disrupting these genes may shed light on the neurobiologi-
cal underpinnings of sleep problems in ASD.
Our study aims to:: 1) determine whether CNVs encompassing circa-
dian and insomnia candidate genes are overrepresented in individu-
als with ASD compared to their unaffected siblings;
2) and if these CNVs are related to sleep phenotypes in ASD.
Methods: We used data from the Simons Simplex Collection (SSC),
a comprehensive phenotyped and genotyped sample of youth with
ASD (4–18 years) and their siblings. Microarray technology identi-
fied CNVs and pipeline detections from our previous publications
were applied to call CNVs.
A rare CNV was annotated if found in < 0.1% of parents and gen-
eral controls. Parent reported weekly sleep duration (minutes) and
insomnia traits (‘difficulty falling asleep’ and ‘frequent night awak-
enings’) were reported for ASD youth only. Items corresponding to
‘yes’ were coded as 1 and summed.
Results: After a microarray quality control 2,571 ASD youth and 2,092
siblings remained. A logistic regression revealed significantly over-
represented duplications (p < 0.01; Odds ratio 2.2; CI95%[1.3;3.7])
and deletions (p < 0.001; Odds ratio 5.0; CI95%[1.7;14.6]) encom-
passing circadian genes, along with greater deletions encompassing
insomnia risk genes in ASD compared to siblings
 |
250 of 356       ABSTRACTS
(p < 0.001; Odds ratio 1.4; CI95%[1.0;1.9]). ASD youth carrying a
rare circadian duplication had significantly decreased sleep by
25 minutes (β= -­24.9, p < 0.001), while youth with a rare insomnia
candidate gene duplication were more likely to have two insomnia
traits (β= 0.63, p < 0.01). Unselected CNVs were not significantly
associated with sleep phenotypes. All models controlled for age, sex
and non-­verbal IQ.
Conclusions: Our findings demonstrate that rare genomic variants
within sleep risk genes are enriched in ASD compared to unaffected
siblings, and are associated with parent-­documented sleep distur-
bance. Replication analyses in other ASD and control cohorts are
ongoing.
Disclosure: Nothing to disclose.
P370 | Sodium oxybate treatment effects on
sleep architecture in paediatric patients with
narcolepsy with cataplexy
E. Mignot1; R.K. Bogan2; J. Black1,3; R. Parvataneni3; Y.G.
Wang3; Y. Dauvilliers4,5
1
Stanford Center for Sleep Sciences and Medicine, Redwood City;
2
University of South Carolina School of Medicine, Columbia; 3Jazz
Pharmaceuticals, Inc., Palo Alto, CA, United States; 4Sleep and Wake
Disorders Centre, Department of Neurology, Gui de Chauliac Hospital;
5
University of Montpellier, INSERM U1061, Montpellier, France
Objectives/Introduction: Sodium oxybate (SXB) is approved for cat-
aplexy and excessive daytime sleepiness in patients with narcolepsy.
A placebo-­controlled, double-­blind, randomised-­withdrawal study
established the efficacy and safety of SXB in paediatric patients
7–17 years of age (Part 1, ≤1 year). An open-­label (OL) safety study
(Part 2) provided SXB treatment for up to 2 additional years. The
objective of this analysis was to report the effects of SXB on sleep
architecture in the paediatric study of participants with narcolepsy.
Methods: Participants with narcolepsy with cataplexy (7−16 years of
age at screening) were eligible. SXB-­naive participants were titrated
to an optimal SXB dose and entered a 2-­week stable-­dose period
(SD). Participants already taking SXB entered the SD at their optimal
dose. After the SD, participants received placebo or continued SXB
treatment in a 2-­week, double-­blind, randomised-­withdrawal period
(DB), then entered OL treatment for up to 47 weeks (Part 1). SXB-­
naive participants underwent polysomnography during screening
(before initiating SXB), end of the SD (optimal dose), and end of Part
1 (optimal dose). Participants taking SXB at study entry underwent
polysomnography at screening and end of Part 1 (taking SXB).
Results: Of 106 participants, 85 completed Part 1. In SXB-­naive
participants, changes from screening to end of the SD included
arousals/night (median [Q1, Q3] change, −43.0 [−58.0, −17.0]) and
percentage of time in non-­rapid eye movement (non-­REM) stage 1
sleep (N1%; −4.6% [−7.5, −0.6]) and non-­REM stage 3 sleep (N3%;
12.6% [7.1, 20.9]). These changes were maintained through the end
of Part 1. In participants taking SXB, sleep architecture remained
similar from screening to end of Part 1. Treatment-­emergent adverse
events (TEAEs) > 10% during Part 1 were enuresis, nausea, vomiting,
headache, and decreased weight. TEAEs with onset in Part 2 in > 2
participants were upper respiratory tract infection and nasopharyn-
gitis. Increased mean blood pressure was observed in Part 2; how-
ever, blood pressure and other vital signs generally remained within
normal range throughout the study.
Conclusions: Open-­label SXB treatment in children with narcolepsy
was associated with reduced arousals, reduced light sleep, and in-
creased deep sleep. Treatment effects and TEAEs were consistent
overall with adults.
Disclosure: Support: Jazz Pharmaceuticals. E Mignot has received
research support from Apple, Jazz Pharmaceuticals, Merck, and
GlaxoSmithKline, is a consultant for Dreem, Alerion, Orexia, and
Inexia, and is on the speakers’ bureau for Vox Media. RK Bogan has
served on the speakers’ bureau and participated in advisory boards
for Jazz Pharmaceuticals and Harmony Biosciences. J Black is a part-­
time employee of Jazz Pharmaceuticals and shareholder of Jazz
Pharmaceuticals plc. R Parvataneni and YG Wang are full-­time em-
ployees of Jazz Pharmaceuticals who, in the course of this employ-
ment, have received stock options exercisable for, and other stock
awards of, ordinary shares of Jazz Pharmaceuticals, plc. Y Dauvilliers
is a consultant for and has participated in advisory boards for Jazz
Pharmaceuticals, UCB Pharma, Flamel Technologies, Theranexus,
and Bioprojet.
P371 | Is human sleep duration adaptive to
social activity?
B.C. Holding1; T. Sundelin1; H. Schiller2; T. Åkerstedt1; G.
Kecklund2; J. Axelsson1
1
Department of Clinical Neuroscience | K8, Psychology, Karolinska
Institutet; 2Stockholm University/Stress Research Institute, Stockholm,
Sweden
Objectives/Introduction: Sandpiper birds show an adaptive sleep
pattern in response to social (mating) activity. The primary aim of
the current study was to determine whether a similar phenomenon
can observed in humans. We assessed how variations in sleep dura-
tion were associated with recent-­past and near-­future social activity.
Methods: Over three weeks, 641 working adults logged their be-
haviour every 30 minutes and a sleep diary every morning (ren-
dering > 292,000 activity datapoints). Using generalised additive
mixed-­effect models (GAMMs), we analysed potential bidirectional
and non-­
linear relationships between sleep-­
duration and social
activity.
Results: Social activity during the day predicted subsequent sleep
duration. Our GAMMS revealed that extensive durations of social
activity during the afternoon was associated with longer subsequent
sleep duration. However, evening social activity was associated with
ABSTRACTS
a decrease in sleep duration. These effects remained even after con-
trolling for sleepiness. Looking at the relationship in the opposite
direction, we did not observe a robust relationship between sleep
duration and next-­day social activity.
Conclusions: This study reveals that social activity can have a differ-
ential impact on subsequent sleep duration, depending on the time-­
of-­day. Given that our effects appeared independent of sleepiness,
we can assume that it is an adaptive decision made by humans to
shorten sleep duration in order to continue evening social activity
rather than a physiological alerting effect of social activity.
Disclosure: Nothing to disclose.
P372 | Effect of pharmacological and non-­
pharmacological treatment on sleep pattern and
serum iron levels in an animal model of Restless
Legs syndrome
M. Morais1; B. Franco2; A. Holanda1; L. Simino1; M.
Manconi3,4; A. Torsoni1; A. Esteves1
1
Faculdade de Ciências Aplicadas -­Universidade Estadual de
Campinas, Limeira; 2Faculdade de Educação Física -­Universidade
Estadual de Campinas, Campinas, Brazil; 3Sleep and Epilepsy Center,
Neurocenter of Southern Switzerland, Civic Hospital of Lugano (EOC),
Lugano; 4Department of Neurology, University Hospital, Inselspital,
Bern, Switzerland
Objectives/Introduction: The pathophysiology of Restless Legs
Syndrome (RLS) may be associated with dopaminergic dysfunction,
genetic variations, and iron deficiency. This study aimed to verify the
effect of physical exercise (PE) and pramipexole (PPX) on the sleep
pattern and serum levels of iron, ferritin, and transferrin in the RLS
animal model (Spontaneously Hypertensive Rats -­SHR).
Methods: The animals were distributed among groups: 1)Standard
control (Wistar-­Kyoto); 2)SHR Control; 3)SHR PE; 4)SHR PE+PPX;
5)SHR PPX; 6)SHR Acute PE. The SHR Control and SHR PE groups
received saline vehicle, while the SHR PPX and SHR PE+PPX groups
received a dose of 0.125 mg/kg of PPX. Chronic PE was performed
on a treadmill (5 sessions per week for 1 h -­moderate intensity). The
interventions lasted 4 weeks. The acute exercise was performed on
a treadmill (60 minutes-­moderate intensity). Electrocorticographic
and electromyographic analyses were performed (baseline/final),
and the levels of iron, ferritin, and transferrin were analysed by the
Enzyme-­Linked Immunosorbent Assay.
Results: In the light period, SHR Control showed more active behav-
iour to Standard control. In the dark period, both showed a similar
sleep pattern. The SHR PPX increased total sleep time, compared
to SHR PE (baseline and final) and SHR Control (final) (p = 0.03), as
well as REM sleep, compared to SHR PE and SHR PE+PPX (final)
(p = 0.006), a cycle light. The PE+PPX reduced the number of awak-
enings compared to SHR Control (baseline and final), SHR PE (base-
line and final) and SHR PE+PPX (baseline) (p = 0.005), and increased
|
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slow-­wave sleep, compared to SHR PE (baseline) and SHR Control
(final) (p = 0.02), in the light period. SHR Control showed higher lev-
els of iron (p = 0.02), and lower levels of ferritin (p = 0.01), com-
pared to Standard control. The SHR PPX showed higher levels of
iron (p = 0.004) and ferritin (p = 0.04), compared to the SHR Control.
Also, chronic PE promoted a greater increase in iron levels (p = 0.02),
compared to acute PE.
Conclusions: SHR Control showed greater expression of RLS symp-
toms in the light period. Both PPX and PE treatment were effective
in improving sleep patterns and reducing symptoms of RLS. Besides,
both treatments increased iron levels.
Financial support: CAPES; FAPESP (#2018/05245-­5).
Disclosure: Nothing to disclose.
P373 | The Impact of COVID-­19 suppression
measures on objectively measured sleep
L. Gahan; B. O'Mullane; R.J. Raymann
SleepScore Labs, Carlsbad, CA, United States
Objectives/Introduction: The COVID-­19 pandemic and associated
restrictions have had a profound impact on peoples’ lives. Both the
abrupt and substantial change in daily routines and the uncertainty
regarding the impact of the outbreak can cause stress and fear. It
has been shown that stress and fear can contribute to a reduction
in deep sleep, sleep efficiency and REM sleep, and an increase in
number of awakenings. Big data analysis was used to investigate the
impact of the COVID-­19 period on objectively measured sleep.
Methods: Sleep data from the SleepScore Mobile Application,
which uses a non-­contact sonar-­based method to capture sleep re-
lated metrics and has been validated against PSG, was used. Data
gathered from 1/1/2020 until 19/4/2020 was included for analy-
sis. The data set included 177,254 nights from 7,873 users, aged
15–89 and all residing in the USA. Linear mixed effect modelling was
used for analysis. The start of the COVID-­19 period was defined as
16/03/2020 and was based on a rise of awareness and concern re-
lated to the disease, as indicated by clear spike in internet search
activity on the topic.
Results: During the COVID-­19 period an increase in Total Sleep Time
(TST) was observed with TST increasing from 354.98 minutes to
362.06 minutes (p < 0.001). The percentage of REM sleep observed
decreased very slightly, going from 19.44% to 19.35 % (p < 0.05).
Sleep Efficiency was also minimally impacted, going from 78.69 to
78.49 (p < 0.001). No significant change in number of awakenings or
percentage of deep sleep were observed.
Conclusions: Despite the external stress factors related to
COVID-­19, we only observed a minor but significant decrease in
both Sleep Efficiency and percentage of REM sleep. Interestingly,
the amount of sleep slightly increased. It appears that the stay-­at-­
home orders issued facilitated a change in the sleep timing, resulting
in a longer sleep duration, that might have allowed for mitigation of
 |
252 of 356       ABSTRACTS
the negative effects of stress or fear related to this period on sleep.
Another explanation that cannot be ruled out is that our regular
userbase is biased towards people less sensitive to stress or anxiety.
Disclosure: All authors are employed by SleepScore Labs.
P374 | Sleep quality and insomnia symptoms
during the COVID-­19 pandemic in a Brazilian
rural population
T. Taporoski1; F. Beijamini2; F. Ruiz3,4; S. Ahmed4; M. von
Schantz4,5; A. Pereira6; K. Knutson1
1
Feinberg School of Medicine, Northwestern University, Chicago, IL,
United States; 2Federal University of Fronteira Sul, Realeza, Brazil;
3
Department of Psychiatry, University of Sao Paulo School of Medicine,
Sao Paulo, Brazil; 4Faculty of Health and Medical Sciences, University
of Surrey, Guildford, United Kingdom; 5Department of Psychiatry,
University of Sao Paulo School of Medicine; 6Incor, University of Sao
Paulo School of Medicine, Sao Paulo, Brazil
Objectives/Introduction: During the coronavirus (COVID-­19) pan-
demic, governments established preventive measurements, such
as self-­isolation and quarantine, to combat the spread of the virus.
Some potential consequences included restricted social interactions,
concerns about the economy, limited physical activity, and dimin-
ished daily sunlight exposure. All of these could negatively impact
sleep. This study investigated the impact of the quarantine order on
self-­reported sleep quality and insomnia symptoms in residents of a
Brazilian rural town, Baependi.
Methods: Participants in an existing family-­
based cohort, the
Baependi Heart Study, were interviewed by phone in April and May
2020, following the quarantine order issued in Baependi on March
2020. The phone interview asked whether participants were com-
plying with the quarantine order (yes/no). Sleep quality was assessed
by the Pittsburgh Sleep Quality Index (PSQI) and insomnia symptoms
were assessed with the Insomnia Severity Index (ISI). Our analyses
compared sleep between those who indicated they were compliant
and ‘quarantined’ (QT) to those who were ‘non-­quarantined’ (NQT).
We adjusted analyses for family structure.
Results: Results comprised data from 592 participants (419 women,
71%) with an average age of 52 (±16) years (42%< 50) and 454 (77%)
indicated they were quarantined. There was a higher prevalence
(p < 0.01) of poor sleepers (PSQI > 5) in the QT group (50%) than
in the NQT group (35%). Compliance with quarantine was associ-
ated with worse sleep quality (QT PSQI = 6.2 (±3.9), NQT PSQI = 4.9
(±3.4); β=1.25, p < 0.01). Greater number of days in quarantine
(range = 1 to 60) was associated with worse sleep quality (β=0.03,
p = 0.02). The association between quarantine and sleep quality was
attenuated with adjustment for gender and age (β=0.73, p = 0.06).
We also observed significantly higher ISI scores (β=0.71, p = 0.01)
in quarantine (QT ISI = 4.70 (±4.6), NQT ISI = 3.96 (±3.9)). This dif-
ference lost significance after adjustment for gender. 5% of the QT
group and 3% of the NQT group reported moderate to severe insom-
nia (ISI > 14) (p = 0.14). The associations between quarantine, sleep
quality and insomnia did not differ by gender or age group.
Conclusions: Our findings showed that individuals compliant with
the quarantine order during COVID-­19 pandemic had worse sleep
quality than non-­quarantined individuals.
Disclosure: Nothing to disclose.
P375 | Effect of the selective melatonin MT1
receptor partial agonist ucm871 in the activity of
norepinephrine neurons of the locus coeruleus
during the sleep/wake cycle
M. Lopez-Canul1; Q. He1; T. Sasson1; R. Ochoa-Sanchez1;
S. Yin1; D. de Gregorio1; L. Posa1; T. Rezai1; S. Comai2; G.
Gobbi1,3
1
Psychiatry, McGill University, Montreal, QC, Canada; 2Neuroscience,
Vita-­Salute San Raffaele University, Milan, Italy; 3McGill University
Health Centre, Montreal, QC, Canada
Objectives/Introduction: Sleep-­wake cycle is controlled and regu-
lated by the interaction between wakefulness and sleep-­regulating
neural circuitry. The Locus Coeruleus (LC)-­
Norepinephrine (NE)
neurons act in both, promoting wakefulness and sleep facilita-
tion switch (Aston-­
Jones et al, 2007). The neuro-­
hormone me-
protein coupled melatonin receptor MT1 are
latonin and its G-­
implicated in the control of neuronal firing activity in sleep regula-
tion (Duvocovich, 2007). However, the role of melatonin MT1 recep-
tor in the LC-­NE modulation is poorly understood due to the lack of
receptor-­selective compounds. Here we constructed a recombinant
adeno‐associated viral vector to constitutively under‐express MT1
receptor (AAVsrhMt1nr1a) in LC-­NE neurons to investigate the ef-
fect of the first selective MT1 receptor partial agonist N-­(2-­{Methyl-­
[3(4phenylbutoxy)phenyl]amino}ethyl) acetamide (UCM871;
Spadoni et al., 2012) in the sleep-­wake cycle.
Methods: Sprague-­Dawley male rats were distributed in 2 groups; 1)
received a bilateral intra LC administration of AAVsrhMt1nr1a and
2) received a bilateral intra LC administration of empty vector (AAV-­
EGFP). After 21 days, the animals were divided in two groups, in the
first group we performed 24 h electroencephalogram (EEG) in free-­
moving rats after subcutaneous injection of vehicle (veh) or UCM871
(14 mg/kg). In the second group, we performed electrophysiology
during the dark phase (10 pm) in order to assess the effect of the
UCM871 (3.5, 7 and 10.5 mg/kg, i.v.) in the LC-­NE activity. Two-­way
ANOVA for RM was used.
Results: Rats injected with empty vector and treated with UCM871
at 14 mg/kg (n = 9) s.c. exhibited an increase in the duration (min)
of REM sleep only during the light phase (veh: 54.28 ± 6.41 n = 7;
UCM871: 88.13 ± 5.81, n = 9, p < 0.05), this effect is cancel in the
AAVsrhMt1nr1a (veh: 55.79 ± 9.05, n = 7; UCM871: 37.30 ± 6.68,
n = 9, p > 0.05) group. Finally, electrophysiology recording shows a
ABSTRACTS
firing rate decrease only in the AAV-­EGFP group (n = 4) after UCM871
administration 7 and 10.5 mg/kg (58.46 ± 10.3%; 66.25 ± 9.9%, re-
spectively, p < 0.05) but not in the AAVsrhMt1nr1a group (n = 4).
Conclusions: These results show that MT1 receptors play an impor-
tant role in REM sleep and in adrenergic function, but in a distinct
manner. While MT1 activation in LC by UCM871 is pronounced in
the dark phase, the effect in the REM sleep is higher during the light
phase.
Disclosure: Nothing to disclose.
P376 | Night shift work and elevated cancer
risk: circadian dysregulation of DNA repair genes
and increased sensitivity to endogenous and
exogenous sources of DNA damage
H. Van Dongen1,2; B. Koritala1,3; K. Porter1,3; O. Arshad4;
R. Gajula3; H. Mitchell4; T. Arman3; M. Manjanatha5; J.
Teeguarden4; J. McDermott4,6; S. Gaddameedhi1,3
1
Sleep and Performance Research Center; 2Elson S. Floyd College
of Medicine; 3Department of Pharmaceutical Sciences, College of
Pharmacy and Pharmaceutical Sciences, Washington State University,
Spokane; 4Computational Biology and Bioinformatics, Pacific
Northwest National Laboratory, Richland, WA; 5Division of Genetic
and Molecular Toxicology, National Center for Toxicology Research,
US Food and Drug Administration, Jefferson, AR; 6Department of
Molecular Microbiology and Immunology, Oregon Health and Science
University, Portland, OR, United States
Objectives/Introduction: Circadian misalignment due to night shift
work is associated with poor long-­term health outcomes, including
increased risk of cancer. We investigated the potential role of dis-
ruption of the circadian transcriptome of hallmark cancer pathway
genes in the elevated cancer risk in shift workers.
Methods: n = 14 healthy human adults (aged 22–34; 10 males, 4
females) participated in a 7-­day (6-­night) laboratory study. Subjects
were exposed to 3 days of either a simulated night shift schedule
(n = 7) with daytime sleep opportunities (10:00–18:00) -­or a simu-
lated day shift schedule (n = 7) with nighttime sleep opportunities
(22:00–06:00). Subsequently, subjects underwent a 24 h constant
routine protocol with blood sampling at 3 h intervals. From the blood
samples collected during the constant routine protocol, lympho-
cytes were harvested and used for investigation. Here we analyzed
the circadian rhythms of 726 mRNA targets from the NanoString
PanCancer Pathway Panel and 17 core clock genes. Furthermore,
we performed ex vivo functional assessments of sensitivity to en-
dogenous DNA damage as well as exogenous DNA damage from
ionizing radiation.
Results: Cosinor analyses showed that the simulated night shift
schedule, as compared to the simulated day shift schedule, caused
widespread disruption of circadian rhythmicity in core clock genes
and among 13 hallmark cancer pathways. There was a marked
|
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difference in circadian rhythmicity in transcripts of the DNA repair
pathway, which was significantly enriched (p < 0.05) for genes exhib-
iting circadian rhythmicity after the simulated day shift schedule, but
not after the simulated night shift schedule. Endogenous DNA dam-
age as assessed with alkaline comet assay was increased (p < 0.001)
and the percentage of cells with DNA damage biomarker foci (BRCA1
and γH2AX) was higher (p < 0.01) after the simulated night shift
schedule. Evening exposure to ionizing radiation (2.5 Gy) caused a
significant increase in DNA damage biomarker foci (p < 0.05).
Conclusions: We observed circadian dysregulation of DNA repair
genes and increased sensitivity to DNA damage in lymphocytes col-
lected under constant routine after 3 days of a simulated night shift
schedule. This indicates that a night shift schedule may be associated
with increased genomic instability, which may lead to elevated can-
cer risk in night shift workers.
Disclosure: Research supported by NIH grants R01ES030113 and
R21CA227381, CDMRP award W81XWH-­18-­1-­0100, and Pacific
Northwest National Laboratory BRAVE investment under DOE con-
tract DE-­AC05-­76RL01830.
P377 | Sleep architecture in mice lacking the
immunoglobulin superfamily member 21
T. Leduc1,2; C. Provost2; P.-G. Roy2; H. Takahashi3; V.
Mongrain1,2
1
Department of Neuroscience, Université de Montréal; 2Center
for Advanced Research in Sleep Medicine, CIUSSS-­NIM; 3Synapse
Development and Plasticity Research Unit, Neurobiology and
Development Research Division, Institut de Recherches Cliniques de
Montréal, Montréal, QC, Canada
Objectives/Introduction: Synaptic adhesion molecules (SAMs) have
been linked to the molecular regulation of sleep duration and qual-
ity. However, few SAMs are known for their exclusive role at the
gamma-­aminobutyric acid (GABA)ergic synapse, even if GABAergic
transmission regulates wakefulness and sleep as well as electro-
corticographic (ECoG) activity. One GABAergic-­specific SAM has
recently been identified, the immunoglobulin superfamily member
21 (IgSF21). IgSF21 was specifically shown to induce GABAergic
synapse differentiation through interaction with presynaptic
Neurexin-­2. We here tested the hypothesis that Igsf21 knockout
(KO) mice would show modifications in sleep architecture, as well as
an altered ECoG response to sleep loss.
Methods: Adult male Igsf21 KO mice and wild-­t ype (WT) littermates
were implanted with electrodes for ECoG and electromyography
(EMG). Mice have been continuously recorded under a 12 h light/12 h
dark cycle for 24 h under baseline (BL)/undisturbed conditions, dur-
ing a 6 h sleep deprivation (SD) starting at light onset, and during
18 h of undisturbed recovery. Vigilance states (wakefulness, slow
wave sleep (SWS), paradoxical sleep (PS)) are now being identified
on 4-­sec epochs. Analysis will include the duration and distribution
 |
254 of 356       ABSTRACTS
of vigilance states and ECoG spectral analysis. Preliminary results
comparing sleep duration and alternation between WT (n = 4) and
Igsf21 KO (n = 5) mice were obtained using independent t-­tests.
Results: Preliminary data for BL show that Igsf21 KO mice spent less
time in SWS during the active (dark) phase in comparison to WT mice
(t  =  −2.4, p = 0.047). During the rest (light) phase, KO mice spent
more time in PS than WT mice (t = 2.5, p = 0.041). There is also a ten-
dency for more consolidation of wakefulness in the active phase in
KO compared to WT mice, with fewer (t = −2.3, p = 0.057) and longer
(t = 2.2, p = 0.062) individual wake episodes.
Conclusions: These preliminary findings reveal that Igsf21 KO mice
have an altered wake/sleep architecture, which suggests a role for
IgSF21 in sleep regulation. Further investigation will reveal whether
these mice have a different response to sleep loss as well as modi-
fications in ECoG activity. This study will bring a deeper insight on
how sleep is regulated at the molecular level.
Disclosure: Nothing to disclose.
P378 | Sleep duration and subjective resilience
to sleep loss predict functional impairment in
elite infantryman during military training
C. Mickelson1; J. Mantua1; T. Burke1; J. Choynowski1; A.
Bessey2; J. Naylor3; Z. Krizan4; W. Sowden5; V. Capaldi1; A.
McKeon1
1
Walter Reed Army Institute of Research, Silver Spring, MD; 2Clemson
University, Clemson, SC; 32d Battalion, 75th Ranger Regiment, Joint
Base Lewis-­McChord, WA; 4Iowa State University, Ames, IA; 5Tripler
Army Medical Center, Honolulu, HI, United States
Objectives/Introduction: Insufficient sleep during military opera-
tions is detrimental to cognition, physical performance, and general
health outcomes. However, there is evidence of inter-­individual dif-
ferences in resilience to sleep loss. Therefore, some Soldiers may
be more resilient to the effects of sleep loss than others. This study
examined the relationship between sleep duration, resilience, and
Soldier wellbeing during a deployment readiness training event.
Methods: Seventy-­six male Soldiers (aged 25.7 + /-­4.0y) from the
75th Ranger Regiment participated while undergoing a two-­week
training exercise. Surveys were administered at the completion of
training and then queried subjective sleep duration during training,
functional impairment (Walter Reed Functional Impairment Scale),
and resilience to sleep loss (Iowa Resilience to Sleepiness Test;
iREST). The independent relationships between sleep duration, re-
silience to sleep loss, and functional impairment were assessed using
linear regression. The interaction between sleep duration and resil-
ience to sleep loss was assessed using SPSS Process (Model 1).
Results: Shorter sleep duration during training predicted higher
functional impairment at end of training (B  =  −0.71, p = 0.001).
Less resilience to sleep loss also predicted higher functional im-
pairment (B = 0.70, p = 0.004). An interaction between sleep
duration and resilience predicted Soldier impairment (R 2 change:
0.06; F(1,68) = 0.17, p = 0.03). Individuals with both shorter sleep
duration during training and less resilience had the higher functional
impairment. Those with more sleep, and those with high resilience
and less sleep, both had lower functional impairment.
Conclusions: This study suggest the iREST can be used as a quick,
subjective screening tool to indicate who may be most vulnerable to
the effects of sleep loss. Identify individual resilience to sleep loss
may be useful in the military context for prescribing sleep strategies
before and during missions in order to enhance Soldier readiness and
performance.
Disclosure: Nothing to disclose.
P379 | EEG and behavioural correlates of mild
sleep restriction and vigilance
A. Gibbings1,2; L.B. Ray1; N. Berberian2; A. Shahidi Zandi3;
A.M. Owen4; F.J.E. Comeau3; S.M. Fogel1,2,5
1
The Royal's Institute for Mental Health Research; 2School of
Psychology, University of Ottawa, Ottawa; 3Alcohol Countermeasures
Systems, Toronto; 4The Brain and Mind Institute, Western University,
London; 5University of Ottawa, Brain & Mind Research Institute,
Ottawa, ON, Canada
Objectives/Introduction: Much is known about the behavioural and
cognitive consequences of chronic sleep loss, but relatively little is
known about the changes in brain activity associated with reduced
vigilance after mild and acute sleep loss. Mild and acute sleep loss is
generally thought to be innocuous despite research showing emo-
tional processing, visual attention and behavioural responding are
all negatively impacted by even small amounts of sleep loss. The
current study investigated behavioural, cognitive, and electrophysi-
ological consequences of mild (i.e., a couple of hours) and acute (i.e., a
single night) sleep loss via simultaneous behavioural and physiologi-
cal measures of vigilance.
Methods: Participants (n = 23; 18 females, Mage = 22 ± 3 years)
came into the lab (from ~12 pm to 3 pm) for two testing days after
sleeping from 1 am to 6 am (Sleep Restriction), or from 12 am to 9
am (Normally Rested). Brain activity was recorded using electroen-
cephalography (EEG) from 15 scalp derivations while vigilance was
assessed simultaneously using the psychomotor vigilance task (PVT).
Results: Vigilance was reduced in the Sleep Restricted vs. Normally
Rested condition, (F(1,22) = 9.02, p = 0.007). This was exacerbated
over the course of performing the PVT, (F(5,110) = 8.12, p < 0.001).
Sleep Restriction also resulted in increased intensity of alpha burst
activity compared to the Normally Rested condition (F(1,20) = 6.19,
p = 0.022). Lastly, EEG spectral power differed between restriction
sleep conditions across deepening stages of sleep onset, particularly
for frequencies that reflect arousal e.g., delta, alpha and beta activity
(F(1,20) > 5.52, p < 0.029).
ABSTRACTS
Conclusions: These results suggest that even a small amount of
sleep loss, occurring on only one night significantly reduces vigi-
lance and impacts the physiology of the brain in ways that reflect
reduced arousal. Understanding the neural correlates and cogni-
tive processes associated with sleep loss may lead to important ad-
vancements in identifying and preventing potentially deleterious or
dangerous, sleep-­related lapses in vigilance (e.g., in the classroom,
workplace), and when lapses in vigilance can be life threatening (e.g.,
while driving).
Disclosure: Nothing to disclose.
P380 | Parental sleep of 6-­month-­olds: do
primiparous and multiparous differ?
S. Kenny1,2; R. Burdayron1,2; É. Lannes3; K. Dubois-
Comtois4; M.-J. Béliveau2,3; M.-H. Pennestri1,2
1
Educational & Counselling Psychology, McGill University; 2Hôpital
en Santé Mentale Rivière-­des-­Prairies, CIUSSS-­NIM; 3Université de
Montreal, Montreal, 4Université du Québec à Trois Rivières, Trois
Rivières, QC, Canada
Objectives/Introduction: Reduced sleep duration and poor sleep
quality are common among parents during the postpartum period.
Some studies suggest that becoming a parent for the first time rep-
resents a more significant transition than the experience of having
a second or third child. However, few studies have examined this
subject, especially in the context of parental sleep. This study aimed
to examine whether the sleep of primiparous mothers and fathers
differs from that of multiparous parents.
Methods: One hundred and nineteen parents (58 mother-­father
couples, 3 single mothers) of 6-­month-­old infants completed a 14-­
day sleep diary to assess total nocturnal sleep duration, longest con-
secutive nocturnal sleep duration (without interruption), number of
nocturnal awakenings and subjective sleep quality (rated on a 1–10
scale). Analysis of covariance (ANCOVA) models were used to com-
pare the means of each sleep variable between primiparous (one
child; n = 25) and multiparous (more than one child; n = 36) mothers,
and between primiparous (n = 24) and multiparous (n = 34) fathers.
Based on statistically significant correlations with the sleep vari-
ables, the following covariates were used: parental education, pres-
ence of breastfeeding and co-­sleeping frequency.
Results: Multiparous mothers reported a shorter longest consecutive
nocturnal sleep duration (238.40 ± 72.00 vs 309.43 ± 91.84 minutes;
p < 0.05), more nocturnal awakenings (2.19 ± 1.06 vs 1.37 ± 0.88;
p < 0.05), and poorer subjective sleep quality (5.92 ± 1.64 vs
7.12 ± 1.40; p < 0.05) than primiparous mothers. However, primipa-
rous and multiparous mothers reported similar total nocturnal sleep
duration (p > 0.05). The sleep of primiparous and multiparous fathers
did not differ for any of the variables reported (p > 0.05).
Conclusions: Multiparous mothers reported more fragmented sleep,
with a shorter longest consecutive sleep duration and more nocturnal
|
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awakenings, than primiparous mothers. They also rated their sleep
to be of poorer quality than primiparous mothers. However, parity
seems to have less of an influence on paternal sleep. Future research
should confirm these findings using objective measures of sleep and
examine whether group differences in sleep outcomes are associ-
ated with other nighttime parenting practices.
Disclosure: Nothing to disclose.
P381 | Polysomnographic pilot study of a new
mandibular oral device for mild to moderate
obstructive sleep apnea
G. Chiaro1; N. Amato1; F. Fanfulla2; M. Ciocco3; D. Frigerio3;
A. Sada4; R. Piantanida5; M. Pons6,7; M. Manconi1,7,8
1
Neurocenter of Southern Switzerland, Lugano, Switzerland;
2
Respiratory Function and Sleep Medicine Unit, Istituti Clinici Scientifici
Maugeri IRCCS, Pavia, Italy; 3Private Practice, Lugano, Switzerland;
4
Private Practice, Verbania, Italy; 5Department of Otorhinolaryngology,
Civic Hospital of Lugano; 6Department of Pulmonology, Civic Hospital
of Lugano; 7Faculty of Biomedical Sciences, Università della Svizzera
Italiana, Lugano; 8Bern University, Bern, Switzerland
Objectives/Introduction: The main objective of the study consisted
in evaluating the efficacy of a novel MAD in reducing pathological
sleep-­related breathing events and improving overall sleep quality.
The study also sought to evaluate tolerability of and compliance to
MAD therapy.
Methods: This was a monocentric, prospective, open-­label, inter-
ventional, polysomnographic pilot study. The main study outcome
was the reduction in pathological sleep-­related breathing events.
Treatment response was defined as a decrease of ≥ 50% in AHI and
RDI. Treatment success was defined as the normalization of the
AHI (<  5/h). Secondary outcomes included improvement of videopol-
ysomnographic parameters and subjective sleep quality and daytime
somnolence. Side effects, tolerability and compliance to treatment
were adjunctive secondary outcome, measured subjectively by
means of a semi-­structured self-­administered questionnaire.
Results: Twenty subjects (3 females) were enrolled, of which 19
completed the study. Complete treatment success (AHI < 5) was met
in 11 cases. Treatment response (decrease of ≥ 50% in AHI and RDI)
was reached in 13 and 14 cases respectively. The MAD was well tol-
erated and no major side effects were reported.
Conclusions: The MAD was effective in reducing pathological sleep-­
related breathing events. Treatment response and treatment suc-
cess were both met in a large proportion of subjects. The MAD was
well tolerated, with mild side effects occurrence, mostly confined to
salivation issues and initial and transient toothache and temporo-­
mandibular joint discomfort.
Disclosure: None of the authors report any conflict of interest re-
lated to this manuscript. The study was partially supported by an
 |
256 of 356       ABSTRACTS
unrestricted grant provided by Lucera Investments Sagl (Via Curti 5,
6900 Lugano, Switzerland).
P382 | Effect of obesity on anthropometric
features between Asian and Caucasian
population with obstructive sleep apnea: a
cumulative meta-­analysis
1 2 3 4 1
H. Qin ; C.X. Chen ; N. Steenbergen ; Y. Cheng ; T. Penzel
1
Interdisciplinary Center of Sleep Medicine, Charité Universitätsmedizin
zu Berlin, Berlin, Germany; 2Guangzhou Institute of Respiratory
Diseases, State Key Laboratory of Respiratory Disease, the First
Affiliated Hospital of Guangzhou Medical University, Guangzhou,
China; 3School of Medicine, Imperial College London, London, United
Kingdom; 4Department of Respiratory and Critical Care Medicine,
Beijing Jishuitan Hospital, Beijing, China
Objectives/Introduction: Anthropometric measurements are simple
and reachable tools for self-­evaluating and screening patients with
a high risk of obstructive sleep apnea (OSA). However, the accumu-
lated relationship of obesity on the anthropometric characteristics
of OSA is not well understood. The aim of the study was to show
the time-­dependent trend of obese OSA patients and evaluate the
differences in anthropometric obesity-­related profiles between two
different ethnicities.
Methods: A cumulative meta-­analysis was performed to assess obe-
sity metrics in patients with and without OSA between Asians and
Caucasians. We searched Pubmed, Web of Science, Medline and
Scopus up to March 2020. Eligible studies used body mass index
(BMI), neck circumference (NC), waist circumference (WC) and waist
to hip ratio (WHR) as measures of obesity in the adult OSA popula-
tion and controls who underwent in-­lab polysomnography or home
sleep testing.
Results: 40 studies with a total of 19142 subjects were investigated.
Comparison of changes in between patients with and without OSA
showed that OSA patients had a higher BMI [mean difference (MD)
3.12, 95%confidential index (CI) 2.51–3.73], neck circumference
(MD 3.10, 95% CI 2.70–3.51), waist circumference (MD 9.84, 95%
CI 8.42–11.26) and waist-­hip ratio (MD 0.04, 95% CI 0.03–0.05) than
the control subjects. The accumulated time-­dependent increase in
population with OSA was significantly apparent. Compared with
Caucasian patients, Asian patients had lower obesity relevant
variates.
Conclusions: BMI, NC, WC and WHR are associated with OSA in
both ethnic groups. Anthropometry for overall and regional obesity
could facilitate differentiation of patients with OSA from individuals
without OSA by ethnicity.
Disclosure: Nothing to disclose.
P383 | Prediction of sleep disordered breathing
in acute stroke patients: questionnaires cannot
replace objective respiratory testing
M. Dekkers1; C. Horvath2; V. Woerz1; S. Duss1; M. Schmidt1;
A.-K. Brill2; C. Bassetti1
1
Department of Neurology; 2Department of Pulmonary Medicine, Bern
University Hospital (Inselspital) and University Bern, Switzerland, Bern,
Switzerland
Objectives/Introduction: Sleep disordered breathing (SDB) is com-
mon in stroke patients and negatively affects its outcome. How to
diagnose SDB in this setting is a matter of debate. The objective of
this study was 1) to evaluate the performance of five sleep apnoea-­
screening questionnaires to predict SDB in acute stroke patients
and 2) to assess the additional predictive power of stroke specific
factors.
Methods: Within a prospective cross-­
sectional cohort of acute
stroke patients we studied 399 individuals who underwent early
cardiorespiratory polygraphy or apnealink testing. Several SDB
screening tools validated in the general population were assessed
(the Berlin Questionnaire was filled in by the patients; STOP-­BANG,
NoSAS, SACS, and NoApnea scores were calculated). Sensitivity,
specificity, positive predictive values, negative predictive values and
the area under the receiver operating characteristics (ROC) curve
(AUC) of the five questionnaires were calculated for different SDB
severities, determined by AHI 5, 15 and 30/h. We studied the impact
of stroke specific factors on SDB prediction with logistic regression
analysis. Significance was determined at p < 0.05.
Results: In this cohort of stroke patients, the Berlin questionnaire
showed the poorest performance, with an AUC for the AHI thresh-
olds of > 5/h, >15/h or > 30/h between 52.7–55.8%. The other ques-
tionnaires performed significantly better and similar to one another,
with AUC ranging from 65.2% (NoApnea) to 69.2% (STOP-­BANG)
for predicting moderate SDB (AHI > 15/h). Interestingly, the two-­
item NoApnea test (neck circumference & age) showed comparable
performance to more complex questionnaires. Logistic regression
analysis revealed, that, besides age (β=0.033, p = 0.003) and BMI
(β=0.086, p = 0.035), NIHSS at admission (β=0.073, p = 0.049) and
history of myocardial infarction (β=1.093, p = 0.018) were signifi-
cant predictors of moderate SDB. Adding ‘NIHSS’ and ‘history of
myocardial infarction’ to the NoApnea scale and adjusting the age
cut-­offs to stroke specific values did not significantly improve test
performance.
Conclusions: Questionnaires validated in the general population are
not sufficiently accurate to predict SBD in acute stroke patients,
even when stroke specific factors are added. Better screening tools
(besides portable sleep studies) are needed in this setting.
Disclosure: Nothing to disclose.
ABSTRACTS
P384 | Prevalence and determinants of
sleepiness in obstructive sleep apnea patients
K. Baou; M. Vagiakis; A. Minaritzoglou; E. Perraki; E. Vagiakis
Critical Care and Pulmonary Services, Sleep Disorders Center, University
of Athens Medical School, Evangelismos Hospital, Athens, Greece
Objectives/Introduction: Excessive daytime sleepiness (EDS) has
been linked with obstructive sleep apnea (OSA). A basic indication to
diagnose and treat sleep apnea is the presence of subjective daytime
sleepiness. We investigated whether the presence of EDS is related
to anthropometric and sleep routine characteristics, and parameters
of the sleep study in OSA patients.
Methods: A total of 280 patients participated in this study who un-
derwent a sleep study and they were diagnosed with OSA (Apnea-­
Hypopnea Index (AHI)  ≥  5 events/hour). Sleepiness was assessed
with the Epworth Sleepiness Scale (ESS). Participants with EDS were
defined as they had an Epworth Sleepiness Scale score > 10. Patients
had completed a questionnaire about sleep habits and sleep duration.
Results: One hundred sixteen OSA patients (42%) suffered from EDS.
The sleepy patients did not differ on mean age (53.3 ± 11.4 years vs
55.4 ± 13.2 years, p =  0.17), but they were more obese [BMI me-
dian (interquartile range) = 31.13 (28–35.8) kgr/m2 vs 30 (27–34.1)
kgr/m2, p = 0.05] and they had higher apnea-­hypopnea index (AHI)
[AHI median (interquartile range) = 36 (17.5–68) events/hour vs 31
(14–50.75) events/hour, p < 0.05] compared to OSA patients with-
out EDS. The two groups did not differ to nocturnal hypoxemia, and
prevalence of hypertension. Sleepy patients presented suggestive
lower self-­reported sleep hours at night (mean duration at night
sleep 6.99 ± 1.38 vs 7.28 ± 1.5 hours, p = 0.07), with no difference
on nap time, but they had longer total sleep time during the sleep
study [TST median (interquartile range) = 246.5 (182.8–355) min vs
220 (169–308), p < 0.05] compared to non-­sleepy OSA patients.
Conclusions: Sleepy patients with OSA have more severe syndrome,
and they are more obese. They presented lower self-­reported sleep
hours at night, but they had longer total sleep time during the sleep
study. It should be further investigated whether or not sleep time
during the night is an important determinant of EDS.
Disclosure: Nothing to disclose.
P385 | Tonsilar hypertrophy and severity of
obstructive sleep apnea in adults
1 2 1 1
K. Baou ; J. Economides ; M. Vagiakis ; M. Andritsou ; E.
Vagiakis1
1
Critical Care and Pulmonary Services, Sleep Disorders Center,
University of Athens Medical School, Evangelismos Hospital, 2ENT
Department, Elpis Hospital, Athens, Greece
Objectives/Introduction: Obstructive sleep apnea (OSA) is a
disorder characterized by symptomatic, repeated upper airway
|
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obstruction during sleep. The pathogenesis of this obstruction is
frequently multifactorial, and tonsilar hypertrophy might represent
a potential factor that aggravates this obstruction. The aim of this
study was to investigate the role of tonsilar hypertrophy and tonsil-
lectomy on severity of obstructive sleep apnea in adults.
Methods: The study consisted of 280 patients diagnosed with
OSA, from those 32 patients (11%) had a tonsillectomy over the last
10 years, and 29 patients (10.3%) presented with hypertrophic ton-
sils at the physical examination. Excessive daytime sleepiness (EDS)
was measured by Epworth scale. The diagnosis of OSA was estab-
lished when the Apnea-­Hypopnea Index(AHI) was ≥ 5 event/hour on
the attended overnight polysomnography.
Results: Patients with hypertrophic tonsils, were males (69%), had
increased prevalence of EDS (59% vs 39%, p < 0.05), and increased
prevalence of tiredness (83% vs 60%, p < 0.05), they were younger
47 ± 11y vs 56 ± 12y (p < 0.001) compared to the rest of the patients.
Also, they had more severe OSA syndrome AHI = 51.6 ± 32.8 events/
hour vs 39.9 ± 27 events/hour (p < 0.05), compared to patients with-
out hypertrophic tonsils. The groups did not differ on BMI.
Conclusions: Tonsillar hypertrophy is an important determinant of
OSA severity and should be taken into account in young individuals
with OSA diagnosis.
Disclosure: Nothing to disclose.
P386 | Long-­term effects of solriamfetol on
quality of life in participants with excessive
daytime sleepiness associated with narcolepsy or
obstructive sleep apnoea
A. Malhotra1; J.-L. Pepin2; R. Schwab3; C. Shapiro 4; J.
Hedner5; M. Ahmed6; N. Foldvary-Schaefer7; P.J. Strollo8;
G. Mayer9,10; K. Sarmiento11; M. Baladi12; M. Bron12; P.
Chandler12; L. Lee12; T.E. Weaver13
1
Division of Pulmonary, Critical Care and Sleep Medicine, University
of California San Diego Medical Center, La Jolla, CA, United States;
2
Grenoble Alpes University Hospital, Grenoble, France; 3University
of Pennsylvania Medical Center, Philadelphia, PA, United States;
4
University of Toronto, Toronto, ON, Canada; 5Sahlgrenska University
Hospital, Gothenburg University, Gothenburg, Sweden; 6Cleveland
Sleep Research Center; 7Cleveland Clinic Lerner College of Medicine,
Cleveland, OH; 8University of Pittsburgh/Veterans Administration
Pittsburgh Health System, Pittsburgh, PA, United States; 9Hephata
10 11
Klinik, Schwalmstadt; Philipps University, Marburg, Germany; San
Francisco Veterans Administration Healthcare System, San Francisco;
12 13
Jazz Pharmaceuticals, Palo Alto, CA; Department of Biobehavioral
Health Science, College of Nursing, University of Illinois at Chicago,
Chicago, IL, United States
Objectives/Introduction: Solriamfetol, a dopamine/norepinephrine
reuptake inhibitor, is approved in the EU and US to treat excessive
daytime sleepiness (EDS) associated with narcolepsy (75–150 mg/
 |
258 of 356       ABSTRACTS
day) or obstructive sleep apnoea (OSA; 37.5–150 mg/day).
Solriamfetol demonstrated improvements on quality-­of-­life (QoL)
measures in 12-­
week, placebo-­
controlled studies in participants
with narcolepsy or OSA. The current study evaluated long-­term ef-
fects (up to 52 weeks) of solriamfetol on QoL.
Methods: Participants from the US (85%), EU (11%), and Canada (4%)
with narcolepsy or OSA who completed previous solriamfetol stud-
ies were eligible for the long-­term study (NCT02348632). A 2-­week
titration period was followed by a maintenance phase of ≤ 50 weeks
(stable doses of 75, 150, or 300 mg/day). Mean (SD) changes from
baseline on the Functional Outcomes of Sleep Questionnaire short
version (FOSQ-­
10), Work Productivity and Activity Impairment
Questionnaire: Specific Health Problem (WPAI:SHP), and 36-­Item
Short Form Health Survey version 2 (SF-­36v2) were summarised for
the overall safety population and by indication (OSA or narcolepsy
subgroups). No formal statistical testing was performed.
Results: There were 643 participants (417 OSA, 226 narcolepsy) in
the safety population. Improvements in FOSQ-­10 total score (mean
[SD] change of 3.7 [3.0]) were sustained for the duration of solriam-
fetol treatment; changes were similar between narcolepsy and OSA.
On WPAI:SHP, participants reported  ≥  25% reduction (improve-
ment) for % activity impairment outside of work, % impairment while
working (presenteeism), and % overall work impairment; results were
generally similar for each subgroup. For SF-­36v2, both physical and
mental component summary scores showed improvements in par-
ticipants’ health state (mean [SD] changes of 3.1 [6.9] and 4.3 [8.4],
respectively); these improvements were maintained for the study
duration. Common adverse events (≥5%) included headache, nausea,
insomnia, nasopharyngitis, dry mouth, anxiety, decreased appetite,
and upper respiratory tract infection, and were similar in narcolepsy
and OSA; 27 participants (4.2%) had ≥ 1 serious adverse event.
Conclusions: Solriamfetol demonstrated sustained improvements
on functionality and work productivity measures for up to 52 weeks
in participants with EDS associated with narcolepsy or OSA. Safety
was similar in the narcolepsy and OSA subgroups.
Disclosure: A Malhotra has served as a principal investigator for a
Jazz study but receives no outside personal income as a recent of-
ficer of the American Thoracic Society; ResMed gave a philanthropic
donation to the University of California San Diego in support of a
sleep center. J-­
L Pepin has received lecture fees or conference
traveling grants from Resmed, Perimetre, Philips, Fisher and Paykel,
AstraZeneca, Jazz Pharmaceuticals, Agiradom, and Teva, and has
received unrestricted research funding from ResMed, Philips,
GlaxoSmithKline, Bioprojet, Fondation de la Recherche Medicale
(Foundation for Medical Research), Direction de la Recherche Clinique
du CHU de Grenoble (Research Branch Clinic CHU de Grenoble), and
fond de dotation ‘Agir pour les Maladies Chroniques’ (endowment
fund ‘Acting for Chronic Diseases’). R Schwab has Nothing to dis-
close. C Shapiro has received research funding from the National
Institutes of Health and the Canadian Institutes of Health Research,
and has served on the speakers’ bureau for Jazz Pharmaceuticals. J
Hedner has served on the speakers’ bureaus for AstraZeneca, Philips
Respironics, Itamar Medical, and BresoTec, and serves as a board
member for Cereus Pharma. M Ahmed has Nothing to disclose. N
Foldvary-­Schaefer served as a consultant for Jazz Pharmaceuticals. PJ
Strollo, Jr. has received consultancy fees and honoraria from Inspire
Medical Systems, ResMed, Philips-­
Respironics, Emmi Solutions,
Jazz Pharmaceuticals, and Itamar; has received research funding
from the National Institutes of Health and Inspire Medical Systems;
and has a provisional patent for positive airway pressure with inte-
grated oxygen. G Mayer has served on the speakers’ bureau for UCB
Pharma, Jazz Pharma, and Janssen Pharma; and is a board member
of the International REM Sleep Behavior Study Group. K Sarmiento
serves on advisory boards for Jazz Pharmaceuticals. M Baladi is an
employee of Jazz Pharmaceuticals who, in the course of this employ-
ment, has received stock options exercisable for, and other stock
awards of, ordinary shares of Jazz Pharmaceuticals plc. M Bron is a
former employee of Jazz Pharmaceuticals who, in the course of this
employment, received stock options exercisable for, and other stock
awards of, ordinary shares of Jazz Pharmaceuticals plc. P Chandler
is an employee of Jazz Pharmaceuticals who, in the course of this
employment, has received stock options exercisable for, and other
stock awards of, ordinary shares of Jazz Pharmaceuticals plc. L Lee is
a former employee of Jazz Pharmaceuticals who, in the course of this
employment, received stock options exercisable for, and other stock
awards of, ordinary shares of Jazz Pharmaceuticals plc. TE Weaver
has received royalty fees for the use of the FOSQ-­10 from Jazz
Pharmaceuticals, ResMed, Bayer AD, Cook Medical, Nyxoah, RWS,
Merck & Co., Inc., Verily Life Science, WCG MedAvante Prophase,
Stratevi, and Philips Respironics.
P387 | Multimodal assessment of sleep
misperception in chronic primary insomnia
A.A. Perrault1,2; A. Maltezos1; K. Gong1; M. McCarthy1,3;
J. Suliteanu1; K. Habibi1; F.B. Pomares1,2,3; D. Smith1; J.-P.
Gouin2,3,4; T.T. Dang Vu1,2,4
1
Department of Health, Kinesiology and Applied Physiology, Concordia
University, Sleep, Cognition and Neuroimaging Lab; 2Centre de
Recherche de l'Institut Universitaire de Gériatrie de Montréal; 3Faculty
of Psychology, Concordia University, Stress, Interpersonal Relationship
and Health Lab; 4PERFORM Center, Concordia University, Montreal,
QC, Canada
Objectives/Introduction: Individuals with chronic insomnia fre-
quently present with sleep state misperception (SSM), i.e. under-
estimate sleep duration (TST), overestimate latency to sleep onset
(SOL) and time spent awake after SO (WASO). This study aims at
characterizing SSM in chronic primary insomnia (INS) vs good sleep-
ers (GS) using assessments both in-­lab with polysomnography (PSG)
and at-­home using actigraphy and sleep diaries.
Methods: 43 INS (49.5 ± 14.2 years; 34 females) and 25 GS
(42.72 ± 15.6 years; 16 females) had a screening PSG, followed by
actigraphy combined with sleep diaries for 11.5 (± 2.2) days at home,
ABSTRACTS
then came back at the lab for a second PSG with subjective sleep as-
sessment. SSM scores (subjective minus objective data) were calcu-
lated for TST, SOL, WASO using PSG along with self-­reported sleep
for in-­lab SSM, and actigraphy combined with sleep diaries for at-­
home SSM. Group effect on SSM scores were tested using ANOVAs,
with age and sex as covariates. Pairwise t-­tests assessed differences
between subjective and objective measures within each group.
Results: SSM for TST was different between groups, both in-­lab
(F(1,64) = 16.3, p < 0.001) and at-­home (F(1,64) = 27.03, p < 0.001),
with an underestimation of TST in INS both in-­lab and at-­home (all
p < 0.001) and an overestimation for GS only at home (p < 0.001).
There was no in-­lab SSM difference between groups for WASO
(F(1,41) = 0.1, p = 0.7), nor difference between PSG and subjec-
tive WASO in either group (p > 0.05). There was a group effect
for at-­home WASO SSM (F(1,64) = 12.12, p = 0.001), with GS un-
derestimating (p < 0.001) and INS overestimating it (p = 0.02).
Both assessments revealed a group effect on SSM for SOL (in-­lab:
F(1,64) = 5.08, p = 0.028; at-­home: F(1,64) = 8.5, p = 0.005), with GS
underestimating SOL at-­home (p = 0.007) , while INS overestimated
in-­lab SOL (p = 0.0013). Finally, INS (but not GS) exhibited difference
between in-­lab subjective SOL and latencies to N1 and N2 sleep (all
p < 0.01) but not latency to N3 (p = 0.12).
Conclusions: GS and INS exhibit different patterns of sleep misper-
ception. TST is the only variable for which SSM was similarly de-
tected both in-­lab and at-­home. Individuals with chronic insomnia
may have difficulties perceiving lighter stages of sleep (N1, N2),
which might contribute to their overestimation of sleep onset.
Disclosure: Nothing to disclose.
P388 | Heart rate changes in young adults
with insomnia watching humorous films: an
exploratory study
1 2 2 2
C. Bastien ; E. Sanz-Arigita ; Y. Daviaux ; S. Bouliac ; J.-A.
Micoulaud-Franchi2; J. Taillard2; P. Philip2; E. Altena2
1
École de Psychologie | Université Laval, Laval University, Quebec, QC,
Canada; 2Bordeaux University, Bordeaux, France
Objectives/Introduction: Emotional reactivity in insomnia is af-
fected both subjectively and on a physiological level for negative
emotional material. However, little is known about reactions to posi-
tive stimuli. The objective of this study is to investigate if presenting
short humorous films would lead to heart rate decreases during and
after film viewing and at bedtime in younger adult insomnia patients
compared to normal sleepers.
Methods: Participants were 20 individuals with DSM-­5-­diagnosed
insomnia (27.7 ± 8.6 years) and 18 self-­
reported good sleep-
ers. (27.3 ± 7.2 years). Heart rate was assessed while participants
watched standardized short, 10–40-­s, humorous films, comparable
to humorous short internet films as well as before and after films
in the absence of stimulus input. Each recording session lasted
|
      259 of 356
12 minutes in total. Subjective (diary) and objective (actigraphy)
sleep measures were obtained as well as subjective humour ratings
of the films through a visual analogue scale (VAS).
Results: Even if heart rate increased during the viewing of humor-
ous films, heart rate changes between conditions did not show a sig-
nificant between group difference when comparing absolute heart
rate values, either as an interaction effect (group*condition: F (2,
72) = 0.86; p = 0.43) or as a between-­subjects effect (F (1, 36) = 0.62;
p = 0.44). Subjective ratings of all participants were positively cor-
related with heart rate changes due to film presentation, but no
differences were found between those with and without insomnia
on subjective ratings of the films, film-­related heart rate changes or
when falling asleep.
Conclusions: Humorous films can affect heart rates in younger
adults and is related to subjective humour ratings. Insomnia however
does not appear to affect the experience of positive stimuli, despite
having a more profound effect on negative stimuli. As such, insomnia
effects do not reflect those found in depression where reactivity
to positive stimuli is attenuated. As Delannoy and collaborators ob-
served in normal sleepers, studying the impact of both negative and
positive stimuli on the following night of sleep could be interesting
and also reveal that positive stimuli presentation may be used as an
adjunct treatment for insomnia.
Disclosure: Nothing to disclose.
P389 | Insomnia symptoms severity is
associated with worse cognitive performance:
the moderating effect of biomarkers of dementia
risk factors
A.-A. Baril1; A. Beiser1; E. Sanchez2; V. Mysliwiec3; S.
Seshadri3; J. Himali3; M. Pase 4
1
The Framingham Heart Study, Boston University School of Medicine,
Boston, MA, United States; 2Department of Neuroscience, Université
de Montréal, Montreal, QC, Canada; 3Glenn Biggs Institute for
Alzheimer's and Neurodegenerative Diseases, University of Texas
Health Science Center at San Antonio, San Antonio, TX, United States;
4
Turner Institute for Brain and Mental Health, Monash University,
Clayton, VIC, Australia
Objectives/Introduction: Since insomnia may be a risk factor for
dementia, we aimed to evaluate whether the severity of insomnia
symptoms was associated with cognitive function in middle-­aged
and elderly individuals. We also evaluated whether this relationship
was modified by the presence of other dementia risk factors, namely
the apolipoprotein E4 (APOE4) allele and systemic inflammation as
measured by C-­reactive protein (CRP) levels.
Methods: We studied 525 participants (62.6 ± 8.7 years, 48.8%M)
in the Framingham Heart Study aged ³40 years without neurological
diseases. Single scores were computed for self-­reported insomnia
symptoms (trouble falling asleep, difficulty resuming sleep, early
 |
260 of 356       ABSTRACTS
awakening, feeling unrested, not getting enough sleep) and global
cognition (principal component analysis of a comprehensive neu-
ropsychological assessment); Higher scores reflected either greater
insomnia symptoms severity or better global cognitive function. We
also examined selected neuropsychological tests. Linear regressions
were used to assess the association between insomnia symptoms
and cognitive function. Model 1 adjusted for age squared, sex, edu-
cation, and years between insomnia and cognitive assessments
(3.3 ± 1.0 years). Model 2 additionally adjusted for APOE4 allele,
Framingham Stroke Risk Profile scores, sleep medication use, body
mass index, and depression. To evaluate potential effect modifica-
tion, we included interaction terms by APOE4 allele status and CRP
levels, adjusted for model 1.
Results: Each score unit increase in insomnia symptoms severity was as-
sociated with lower global cognitive performance (B = −0.03;SE = 0.01;
p = 0.01), Logical Memory Immediate (B = −0.10;SE = 0.04; p = 0.003)
and Delayed Recall (B = −0.13;SE = 0.04; p = 0.0009), and Similarities
(B  =  −0.08;SE  =  0.04; p = 0.04) adjusted for both models 1 and 2.
APOE4 allele and CRP levels each significantly interacted with insom-
nia symptoms to explain Delayed Recall performance. APOE4 carri-
ers presented a stronger association between insomnia symptoms
and worse memory recall (B = −0.26;SE = 0.08; p = 0.003) than non-­
carriers (B = −0.08;SE = 0.04; p = 0.04). No association was observed
in those with low CRP levels (< 1 mg/L); whereas, insomnia symptoms
were associated with worse memory recall in participants with average
(1–3 mg/L; B = −0.19;SE = 0.08; p = 0.01) and high CRP levels (>3 mg/L;
B = −0.13;SE = 0.06; p = 0.02).
Conclusions: More severe insomnia symptoms were associated with
worse global cognition, verbal memory and reasoning. Worse verbal
memory recall was especially apparent in those with APOE4 allele
and inflammation, suggesting that insomnia might affect cognitive
functioning particularly when the brain is already vulnerable to neu-
rodegenerative processes.
Disclosure: The authors report no conflict of interest.
P390 | The effect of CBTi on subjective and
objective cognitive performance in chronic
primary insomnia
F.B. Pomares1,2,3; A.A. Perrault1,2,3; D.M. Smith1,4; J.
Suliteanu1; K. Habibi1; J.-P. Gouin3,5; T.T. Dang-Vu1,2,5
1
Sleep, Cognition and Neuroimaging Lab, Department of Health,
Kinesiology and Applied Physiology & Centre for Studies in Behavioral
Neurobiology, Concordia University; 2Centre de Recherche de l'Institut
Universitaire de Gériatrie de Montréal, CIUSSS Centre-­Sud-­de-­l'Ile-­
de-­Montréal; 3Stress, Interpersonal Relationship and Health Lab,
Department of Psychology & Centre for Clinical Research in Health,
Concordia University; 4Department of Psychology, University of
Ottawa; 5PERFORM Centre, Concordia University, Montreal, QC,
Canada
Objectives/Introduction: Evidence for objective cognitive impair-
ment in chronic primary insomnia (PI) are scarce, and few studies
have investigated the effects of cognitive behavioural therapy for
insomnia (CBTi). This study aimed to better characterize: 1) the
changes in cognitive function (working memory and attention) as-
sociated with PI; 2) the effect of CBTi on objective and subjective
cognitive performance in PI.
Methods: Sixty-­t wo PI participants (50.4 ± 16 years old, 49 females)
and 35 good sleeper (GS) participants (43.9 ± 16 years old, 21 fe-
males) were recruited and had a screening polysomnography (PSG).
PI participants were randomized into two groups: immediate CBTi
(TX, 8-­week group CBTi) or waitlist (WL), with measures taken at
baseline and at three months. Cognitive assessments included
the Sahlgrenska Academy Self-­
reported Cognitive Impairment
Questionnaire (SASCI-­Q ), the Attention Network Task (ANT) for at-
tention, and the N-­back task for working memory. ANOVAs were
conducted to assess the effects of group (PI vs GS) or time by group
interaction (TX vs WL, 19 TX and 18 WL were included in these anal-
yses), including age and sex as covariates.
Results: In the ANT, there was no difference in reaction time (RT,
p = 0.91) and accuracy (p = 0.14) between PI and GS. There was no
significant time by group (TX vs WL) interaction on RT (p = 0.8) or
accuracy (p = 0.16).
In the N-­back task, PI performed marginally poorer compared to GS,
with a lower number of hits (p = 0.098) and a higher response la-
tency (p = 0.076) in the 3-­back condition. In TX vs WL comparison,
there was no significant time by group interaction on the number of
hits (p = 0.94) or response latency (p = 0.31) in the 3-­back condition.
Interestingly, the time by group interaction (TX vs WL) for subjec-
tive cognitive impairment (SASCI-­Q ) in PI was marginally significant
(p = 0.062); in the TX group, the decrease in the SASCI-­Q score after
CBTi was marginally significant (p = 0.081).
Conclusions: PI was associated with a trend for an impairment in
working memory but only at a higher level of task difficulty (3-­back).
Subjective cognitive impairment showed a trend for a decrease after
treatment, suggesting that CBTi may have beneficial effects on self-­
reported cognitive complaint.
Disclosure: Nothing to disclose.
P391 | The impact of COVID-­19 awareness and
subsequent daily life changes on weekday and
weekend sleep patterns in the USA
L. Gahan; B. O'Mullane; R.J. Raymann
SleepScore Labs, Carlsbad, CA, United States
Objectives/Introduction: The COVID-­19 pandemic has changed the
weekday routines of many dramatically and weekend routines to a
lesser extent. To slow the spread of the virus both shelter-­in-­place
and social distancing mandates were issued, with non-­essential busi-
nesses also being forced to close. Profound changes in daily routines
ABSTRACTS
are known to impact sleep. We explored how sleep patterns were
impacted by the rise in awareness regarding COVID-­19 and the sub-
sequent mandates.
Methods: Sleep data recorded between 1/1/2020 and 19/4/2020
from the Sleepscore Mobile Application, which uses a non-­contact
sonar-­based method to capture sleep related metrics and has been
validated against PSG were used. The data set included 177254
nights 7873 users, aged 15–89, all USA data). Linear mixed effect
modelling was used for analysis to compare the sleep patterns be-
fore and after the changes in COVID-­19 awareness. The start of
the COVID-­19 awareness was set at 16/3/2020 and was based on a
steep increase in internet searches in the USA related to COVID-­19.
Results: Both time to bed and time out of bed shifted towards later
times during the COVID-­19 period. Average time to bed shifted from
23:22 to 23:40 on weekdays and from 23:52 to 00:01 at weekends
(both p < 0.001). Likewise, average time out of bed shifted from
6:53 to 7:23 on weekdays and from 7:44 to 7:58 at weekends (both
p < 0.001). These shifts in bedtimes resulted in an increase in time in
bed, from 446 to 458 minutes on weekdays and from 467 to 473 at
weekends (both p < 0.001). Finally, an increase in average total sleep
time was observed from 351 to 359 minutes at weekdays and from
368 to 372 minutes during weekends (both (p < 0.001).
Conclusions: The COVID-­19 period resulted in a shift towards a
later sleep schedule, longer sleep period and longer sleep duration in
the users in this data set, with this shift being more pronounced for
weekdays as compared to weekends. The daytime daily life changes
as a result of the COVID-­19 pandemic also extend to the night-­time,
and the habitually observed difference between weekday sleep pat-
terns and weekend patterns have become less pronounced.
Disclosure: All authors are employed by SleepScore Labs.
P392 | The global connection between
happiness and a good night's sleep: a big data
analysis
L. Gahan; M. Ruder; B. O'Mullane; R.J. Raymann
SleepScore Labs, Carlsbad, CA, United States
Objectives/Introduction: Research has shown that self-­
reported
sleep quality and wellness are associated at the individual level; hav-
ing a more positive general outlook on life has been associated with
improved sleep quality. In this series of analyses the relationship be-
tween happiness, as quantified by the World Happiness Index, and
objectively measured sleep was explored on a country by country
basis.
Methods: Sleep data from the SleepScore Mobile Application which
uses a non-­contact sonar-­based method to capture sleep related
metrics and has been validated against PSG was used. The data set
included 1,234,462 nights (72,819 users, range 18–85 years, mean
age: 51.03 + /-­15.17 years, 51.04% female, from 26 countries). The
happiness Index data was taken from the World Happiness Report
|
      261 of 356
2020. This Index is calculated based on individuals’ own assess-
ment of their wellbeing in nationally representative surveys, using
a 11-­point Cantril scale. Linear mixed effect modelling was used for
analysis.
Results: A significant positive relationship was found between a
country's Happiness Index and both the Total Sleep Time (TST) and
Time in Bed (TIB) of users who tracked in the respective nations
(TST: R = 0.69, TIB: R = 0.68. ,both p < 0.001). A 1-­point increase in
Happiness Score was shown to be associated with an extra 8.16 min-
utes of sleep and an extra 9.48 minutes of TIB. Of the countries
included in the analysis, Finland ranked highest (Happiness Score:
7.8), associated with an average TST of 425 minutes, whereas India
(Happiness Score: 4.0) was ranked lowest, with an average TST of
385 minutes.
Conclusions: Users tracking sleep in countries that rank higher on
the Happiness Index are considered to have a more positive out-
look on life and hence are happier people. Users from these high
ranked countries spend more time in bed and sleep longer, as com-
pared to users in countries that are lower ranked on the Happiness
Index ranking. Of note, this data set and analysis does not allow for
a causal interpretation. To unravel causal relationships we suggest
continuous tracking of both happiness and objective sleep, exploring
the relationship of the observed changes in both over time.
Disclosure: All authors are currently employed by SleepScore Labs
P393 | Fragrance affects self-­reported and
objectively measured sleep in healthy women: a
double-­blind, placebo-­controlled crossover field
study
H. Rus1; A. Jain2; S. Danoff-Burg1; M. Weaver1; M. Tabert2;
R. Raymann1
1
SleepScore Labs, Carlsbad, CA, 2IFF, Union Beach, NJ, United States
Objectives/Introduction: An approach to mitigating sleep distur-
bances is using scents to promote relaxation and sleep. To date, most
research on the positive benefits of scent has been anecdotal and fo-
cused on aromatherapy. Scientific rigor and objective measurement
are needed to document any potential effects. This study tested if
a proprietary pillow mist developed by IFF can affect sleep as com-
pared to placebo.
Methods: Healthy females (n = 31; average age 32) who self-­reported
mild sleep disturbances caused by lifestyle and habit factors tracked
their sleep and tested two scented pillow mists at home. A double-­
blind, counterbalanced, crossover design was used. Participants
were instructed to use the active and placebo pillow mists for two
weeks each, with a one-­week washout period following each use pe-
riod. Self-­report data was collected after each use period. Nightly
sleep was measured objectively using ResMed S+ or SleepScore
Max. Paired t-­tests and multilevel regression were used to test for
statistical significance.
 |
262 of 356       ABSTRACTS
Results: Although there was no statistically significant difference in
either self-­reported or objective sleep measures associated with the
active compound as compared to placebo, post hoc analysis revealed
a difference in one subgroup of participants (n = 16). In a subgroup
with the fewest sleep disturbances at baseline (Athens Insomnia
Scale score < 5, applying median split) the subjects showed better
sleep when using the active compound as compared to nights using
the placebo (362 nights of data). They spent 26% less time awake
during the night after falling asleep. They also experienced better
sleep efficiency (2% increase) and sleep maintenance (2% increase)
on nights they used the active compound (p < 0.05). Participants also
perceived 13% fewer awakenings during the night when using the
active compound (p < 0.05).
Conclusions: Using objective sleep measurement and self-­report,
this study showed that the proprietary pillow mist can positively af-
fect sleep in women with an Athens Insomnia Scale < 5. Expanding
this line of research to include males, other age groups, and cross-­
cultural diversity is recommended for further exploring the effects
of the pillow mist, as well as other scents that may have potential as
non-­invasive, non-­addicting means of supporting healthy sleep.
Disclosure: All authors are employees of IFF or SleepScore Labs.
This research was funded by IFF.
P394 | Long shift duration is associated with
high risk for Shift Work Disorder
H.M. Lammers-van der Holst1,2; Y. Zhang3; L.K. Barger1,2;
J.C. Wise1; A.S. Murphy1; B.M. Desnoyers1; S. Qadri1; J.M.
Ronda1,2; J.F. Duffy1,2
1 sleepiness (EDS). The Epworth scale is used for this screening, and
Division of Sleep and Circadian Disorders, Brigham and Women's
2 a value above 8 is indicative of EDS. This scale was validated only in
Hospital, Division of Sleep Medicine, Harvard Medical School, Boston,
MA, 3Solomont School of Nursing, Zuckerberg College of Health
Sciences, University of Massachusetts Lowell, Lowell, MD, United States
Objectives/Introduction: Shift work is associated with a number
of adverse health consequences, including cardiovascular diseases,
gastrointestinal disorders, mental health problems, and cancers.
The most common symptoms related to shift work are sleep distur-
bances and excessive sleepiness, and when severe are characterized
as Shift Work Disorder (SWD), an ICSD-­III classified sleep disorder.
Depending on the criteria, approximately 10–40% of shift workers
have SWD. Shift duration has been identified as an important factor
determining the well-­being of shift workers. The objective of this
study was to evaluate whether shift duration is associated with the
risk for SWD.
Methods: A total of 289 shift workers (19–65 years old (mean age
26), 64% men) from various occupations who worked at least 4
night shifts per month completed a Shift Worker Sleep and Health
Survey. This REDcap online survey included a validated 4-­
item
screening questionnaire which classified participants as either low
risk or high risk for SWD. Respondents were dichotomized based
on their reported typical shift duration, either  ≤  9  hours (n = 212)
or  ≥  10  hours (n  = 77). Non-­parametric Chi-­square analyses were
carried out using SAS software (9.2, Cary, NC).
Results: There was a significant difference between the percentage
of workers at high risk for SWD between those working ≤ 9 h shifts
(25%) and those working ≥ 10 h shifts (39%) (χ2 (1, n = 289) = 4.99,
p  =  0.026). Thus, shift workers working 10 hours or longer shifts
were significantly more likely to be at risk for SWD than those work-
ing 9 hours or fewer.
Conclusions: These preliminary results suggest that longer shift du-
ration is associated with higher risk for SWD. Even though the ad-
verse impact of shift work is multifactorial, including factors related
to the individual, the occupation, and the work schedule, strategies
to prevent SWD in shift workers should consider the effect of shift
duration.
Disclosure: Nothing to disclose.
P395 | Epworth scale -­a method for OSAS
severity stratification?
M. Oliveira1; J. Costa1; G. Samouco1; R. Natal1; S. Braga1; J.
Ribeiro1; A. Tavares1,2; J.M. Silva1,2
1
Pulmonology Department, Unidade Local de Saúde da Guarda, E.P.E.,
Guarda, 2Faculdade de Ciências da Saúde da Universidade da Beira
Interior, Covilhã, Portugal
Objectives/Introduction: Obstructive sleep apnea syndrome
(OSAS) is often diagnosed by the presence of excessive daytime
a population of australian middle-­aged men, and the value for OSAS
severity stratification is still controversial.
We aim to correlate the Epworth scale with the severity of OSAS.
Methods: Retrospective study in patients referred to our Sleep lab
for 2 years. Collected demographic data, body mass index (BMI),
Epworth scale were collected and, through the polysomnographic
or cardio-­respiratory sleep study, the apnea-­hypopnea index (AHI).
Patients were divided and compared in two groups: with EDS and
without EDS. Inferential statistics using the t-­student test for inde-
pendent samples, with data presented as mean and standard devia-
tion for continuous variables and as a percentage of the total and
number for categorical variables. Statistics were performed using
SPSS® with a significance level of 5%.
Results: We included 367 patients, 74.1% (272) male, mean age 56.9
(±12.7) years, mean BMI of 31.2 (±5.3) Kg/m2, mean Epworth scale
of 7.8 (±4.8) and mean AHI of 27.7 (±26.0). The EDS group comprises
176 patients, 74.1% (272) male, mean age 55.5 (±11.4) years, mean
BMI 31.8 (±5.7) kg/m2, scale mean Epworth of 11.8 (±3.4) and mean
AHI of 30.6 (±28.5). The group without EDS comprises 191 patients,
72.8% (139) male, mean age of 58.1 (±12.9) years, mean BMI of 30.6
(±4.9) kg/m2, scale mean Epworth of 4.1 (±2.3) and mean AHI of 25
ABSTRACTS
(±23.3). The correlation between groups demonstrated a statistically
significant difference in the AHI value (p = 0.038), with no statisti-
cally significant differences in age or gender.
Conclusions: Our data suggest that patients with EDS have severe
OSAS, while patients without EDS have moderate OSAS. Epworth
scale proves effective to screen patients with severe OSAS while
continuing the gold-­standard for EDS diagnosis.
Disclosure: Nothing to disclose.
P396 | A role for cellular stress in age-­related
sleep impairments and cognitive decline
J. Hafycz; N. Naidoo
Chronobiology and Sleep Institute, University of Pennsylvania,
Philadelphia, PA, United States
Objectives/Introduction: The maintenance of proteostasis is critical
for the proper functioning of cells, and therefore an organism as a
whole. With age, the molecular mechanisms that relieve cellular stress
and assist in the proper folding of proteins become less efficient. In
addition to this perturbation of proteostasis, sleep quality is impaired
with age, as are cognitive impairments. It is known that sleep depriva-
tion leads to cellular stress and vice versa in young adult mice. Further,
it is known that protein synthesis is necessary for memory formation.
It is unknown if there is a causal link between cellular stress, sleep
quality, and cognition. In the following study, we use a mouse model
of aging to determine if reducing cellular stress via increasing protein
chaperone levels will improve sleep quality and memory.
Methods: Aged mice (18 mos. old) and young mice (2–3 mos. old)
were administered the chemical chaperone 4-­phenyl butyrate (PBA)
by weekly injections and in the drinking water. Controls were given
a vehicle solution in drinking water and I.P. injections of sterile sa-
line. After 8 weeks of treatment mice were subjected to EEG implant
surgery and were allowed two weeks recovery as treatment contin-
ued. After 10 weeks, mice were subjected to cognitive tasks, Spatial
Object Recognition and Y-­maze Tests. Mice were then connected to
EEG recording cables and recording took place for two days follow-
ing acclimation. Mice were perfused and tissue collected for both
immunohistochemistry and Western blot analysis.
Results: Preliminary results suggest that PBA treatment improves
performance in the aged mice in the memory tests. Data from sleep
and tissue analyses in progress will be presented. IHC and Western
blot assays will focus on markers of cellular stress and memory for-
mation pathways.
Conclusions: These results suggest that reducing cellular stress im-
proves cognition in a wildtype mouse model of aging. While sleep
and histological data analyses are still in progress, the implications of
these results could have an impact on the development of therapies
to improve healthspan in the growing aged population.
Disclosure: Nothing to disclose.
|
      263 of 356
P397 | Pupillometry is a promising noninvasive
method for determining lighting effects on
human physiology
J. de Zeeuw1,2,3; A. Papakonstantinou1,2; C. Nowozin1,2; S.
Stotz1,2; M. Zaleska3; S. Hädel1; F. Bes1,2; M. Münch1,2,4; D.
Kunz1,2,3
1
Institute of Physiology, Sleep Research & Clinical Chronobiology,
Charité -­Universitätsmedizin Berlin, Corporate Member of Freie
Universität Berlin, Humboldt-­Universität zu Berlin, and Berlin
Institute of Health; 2Clinic for Sleep & Chronomedicine, St. Hedwig-­
Krankenhaus; 3Intellux GmbH, Berlin, Germany; 4Sleep/Wake
Research Centre, Massey University, Wellington, New Zealand
Objectives/Introduction: We investigated the effects of daytime
light exposure on the pupillary light reflex (PLR). Our hypothesis was
that the PLR might be used as an objective marker that shows to
what extent daytime lighting conditions affect physiology. The abil-
ity of the PLR to distinguish between relatively similar lighting condi-
tions was determined by using polychromatic white light conditions
that differed in peak wavelength within the blue range of the light
spectrum and/or differed in light intensity. The results were pub-
lished in the Journal of Biological Rhythms (de Zeeuw et al., 2019).
Methods: Participants arrived at the laboratory one hour past
habitual wake-­
up time during four visits (n  = 72; 48 female;
24.4 ± 2.7 years; mean ±SD). Three hours after habitual wake-­up
time participants were exposed to 3 h of polychromatic white light.
The lighting conditions differed in peak wavelength (= 3500 K; blue
light peak at 435 nm or at 480 nm) and in light intensity (100 lx,
200 lx, 600 lx, 1200 lx). All lighting conditions had a similar color
temperature (CCT = 3500 K), except for the control condition in dim
light (< 5 lx). The PLR was measured with a handheld device four
times during each visit. The first measurement was dark-­adapted
(10 min, 0 lx) followed by three light-­adapted measurements (in the
respective light condition). The maximal pupil contraction amplitude
(max CA) and the post-­illumination pupil response (PIPR) were deter-
mined following a 1-­s light pulse.
Results: The max CA and PIPR were significantly reduced by lighting
conditions of different spectral composition (p < 0.001) and light in-
tensity (p < 0.001). A dose response curve with melanopic irradiance
(= weighted illuminance based on the melanopsin photopigment)
could be fitted to the data for the max CA (p = 0.001, R 2=0.879) and
the PIPR (p = 0.002, R 2=0.822).
Conclusions: Our results show that the PLR may be used as a physi-
ological marker for the effects of ambient light exposure during
daytime. Since pupillometry is noninvasive and relatively easy to
measure, compared to present gold standards like melatonin sup-
pression, it could be of great help in practical situations aiming to
improve lighting situations for example at workplaces.
Disclosure: Nothing to disclose.
 |
264 of 356       ABSTRACTS
P398 | Rapid fast-­delta decay following
prolonged wakefulness marks a phase of wake-­
inertia in NREM sleep in both mice and humans
J. Hubbard1; T.C. Gent2,3; M.M.B. Hoekstra4; Y.
Emmenegger4; V. Mongrain5; H.-P. Landolt6; A.R.
Adamantidis2,7; P. Franken4
1 2
University of Lausanne, Lausanne; Department of Neurology,
Inselspital University Hospital, Bern; 3Department of Veterinary
Anesthesia, University of Zurich, Zurich; 4Centre for Integrative
Genomics, University of Lausanne, Lausanne, Switzerland;
5
Department of Neuroscience, University of Montreal, Montreal, QC,
Canada; 6Institute of Pharmacology and Toxicology, University of
Zurich, Zurich; 7Department of Biomedical Research, University of
Bern, Bern, Switzerland
Objectives/Introduction: Sleep-­
wake driven changes in NREM
sleep (NREMS) EEG delta (δ-­)power are widely used as proxy for a
sleep homeostatic process. Here, we noted frequency increases in
δ-­waves in sleep-­deprived mice, prompting a re-­evaluation of how
slow-­wave characteristics relate to prior sleep-­wake history.
Methods: 38 male C57BL/6 mice were implanted with EEG/EMG
and exposed to 48-­hours of baseline (12hLight:12-­hDark) condi-
tions, followed by a 6-­hour sleep deprivation (SD). A subset of these
mice (n = 9) were implanted with thermistors to record cortical tem-
perature. An additional group was implanted with tetrodes in tha-
lamic and cortical areas and subjected to optogenetic inhibition of
the central midline thalamic nuclei. Healthy human male subjects
recorded with EEG who underwent baseline conditions followed by
a 40 h sleep deprivation, were also included (n = 110).
Results: Here we identified two classes of δ-­waves; one responding
to sleep deprivation with high initial power and fast, discontinuous
decay during recovery sleep (δ2: 2.5–3.5 Hz) and another unrelated
to time-­spent-­awake with slow, linear decay (δ1: 0.75–1.75 Hz). This
δ-­band heterogeneity after sleep deprivation was also present in
human subjects, though was slower (δ2: 1.5–2 Hz, δ1: 0.5–1 Hz).
Similar to sleep deprivation, silencing of centromedial thalamus
neurons in mice specifically boosted subsequent δ2-­waves (n  = 4).
Furthermore, these δ2-­dynamics paralleled those of cortical tem-
perature, muscle tone, higher frequency brain activity, and neuronal
ON-­/OFF-­state lengths, all reverting to characteristic NREMS lev-
els within the first recovery hour. In humans, this was the case for
alpha activity during NREMS (8–11 Hz), as well as cardiac rhythm and
heart-­rate variability.
Conclusions: The relationship of these two δ-­wave-­populations and
their respective sleep-­wake dependent dynamics to concomitant
changes in a number of physiological variables, underlies a transient
NREMS state. This presents an inherent paradox, as the deepest lev-
els of NREMS, when recovery is presumed to be most efficient, in
fact display several signatures more reminiscent of waking, suggest-
ing the existence of a wake inertia phenomenon.
Disclosure: Nothing to disclose.
P399 | Sleepcoaching: non-­pharmacological
treatment of non-­restorative sleep in Austrian
railway shift workers
B. Holzinger1,2; L. Mayer1; K. Levec1; M.-M. Munzinger1; G.
Klösch1,2
1
Institute for Consciousness and Dream Research, 2Medical University
Vienna, Vienna, Austria
Objectives/Introduction: Sleepcoaching by Holzinger & KlöschTM
is a new, Gestalt therapy-­
based holistic approach to non-­
pharmacological treatment of non-­
restorative sleep. It includes
psychotherapeutic aspects which enable participants to improve
their sleep quality by developing their own coping strategies as a
daily routine, dream work and relaxation techniques. The aim of this
study was to measure the effectiveness of a two-­day sleepcoach-
ing seminar on sleep and life quality and daytime sleepiness in shift
workers employed in an Austrian railway company (Österreichische
Bundesbahnen, ÖBB).
Methods: Thirty shift workers (28 male; mean age = 24 ± 45.90,
age range 24–56 years) answered a survey before and six months
after the seminar (baseline and follow-­up) containing items of the
Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale
(ESS), and questions regarding their chronotype, personality fac-
tors, and burnout risk factors. To see whether group results before
and after differed, Wilcoxon-­Tests were conducted and effect sizes
(Pearson r) were calculated. The baseline findings in this group were
compared with who did not take the follow-­up survey (n = 154) to
see if the two groups differed significantly enough to create a bias
among completers by using ANOVA and Welch´s t test. For statisti-
cal analysis, the threshold for the rejection of the null hypothesis
was set to p = 0.0038 after Bonferroni correction.
Results: Groups differed significantly in burnout levels [F(1,
182) = 5.13, p  <  0.025] and sleep duration [F(1, 182) = 20.91,
p < 0.001]. No difference was found in regard to the distribution
of critical PSQI score (>5) (χ2 = 0.203, df = 1, p = 0.653) or critical
ESS score (>10) (χ2 = 0.312, df = 1, p = 0.577). The seminar lead to
a significant improvement of global PSQI score, daytime sleepiness
(ESS), and PSQI subscales sleep quality, diurnal fatigue, sleep latency. A
medium treatment effect was found for all those variables.
Conclusions: The two-­day sleepcoaching seminar resulted in signifi-
cant improvement in relevant aspects of sleep. Unfortunately, not all
aspects could be addressed, possibly due to the short duration of the
intervention. More research with a larger sample and a longitudinal
design is needed to establish the long-­term effects of sleepcoaching.
Disclosure: Conflict of interest: Authors Brigitte Holzinger and
Gerhard Klösch have been involved in the design and application
of the sleep coaching programme Holzinger & KlöschTM. Other au-
thors declare no conflict of interest. Funding: The SC seminars were
financed by the Österreichische Bundesbahnen (ÖBB). However, we
received no funding for the study presented.
ABSTRACTS
P400 | Hypocretin-­orexin and melanin
concentrating hormone interplay in narcolepsy
1 2
S. Chaudhari ; K. Chaudhari ; R. Tiwari 3 could provide breakthrough is NC pharmacotherapy.
1
Department of Internal Medicine, Seth Gordhandas Sunderdas
2
Medical College, Mumbai, India; Department of Neurology, University
of Oklahoma Health Sciences Center, Oklahoma City, OK, United
States; 3Department of Samhita Siddhanta, Smt. K.G. Mittal Punarvasu
Ayurvedic College, Mumbai, India
Objectives/Introduction: While Hypocretin/Orexin (Hcrt/Ox)
deficiency accounts for narcolepsy with cataplexy (NC), broader
network-­
level modulations of lateral hypothalamic (LH) circuits
provide a more comprehensive explanation for its symptoms.
Neurophysiologically, NC is marked by untimely activation of rapid
eye movement (REM) circuits, triggering intrusion of REM-­
like
phases and muscle atonia into wakefulness; often described as ‘poor’
boundary state control. Bursts of hypersynchronous theta activity
and multiphasic behavioral transitions beginning with wakefulness,
predominantly seen in boundary states make a case for exploring
REM-­independent pathomechanisms of NC. We explored the role of
factors affecting circuit-­level interplay between Hcrt/Ox and mela-
nin concentrating hormone (MCH) to sleep-­wake homeostasis that
is dysregulated in NC.
Methods: A systematic review of articles with English abstracts
from PubMed, Medline, Web of Science, Scopus, and EMBASE da-
tabases was conducted using keywords narcolepsy, cataplexy, hypo-
thalamus, Hcrt/Ox, MCH, and neurotransmitters with no publication
date limitations. Factors like NC phenotype (animal models), clinical
presentation (human studies), genotype alterations, resultant sleep
architecture, electroencephalographic (EEG) patterns, polysomnog-
raphy findings, Hcrt/Ox levels, other neurotransmitters altered or
assessed, neuroanatomical tracing results, and concomitant behav-
ioral changes were assessed before review.
Results: Sleep-­wake cycle homeostasis is maintained by the recip-
rocal activity of hypothalamic Hcrt/Ox (wake predominant) and
MCH (night predominant) neurons. Altered gamma-­
aminobutyric
acid (GABA) receptor expression blunts Hcrt/Ox-­MCH during their
predominant stages leading to NC-­related boundary state instability,
which is countered by co-­released and wake-­promoting dynorphin.
Besides GABA innervations, LH receives projections from bed nu-
clei of stria terminalis (cholecystokinin), accumbens and habenular
nuclei and sends connections to locus coeruleus (noradrenergic),
dorsal raphe (serotonergic), and ventrolateral periaqueductal gray/
lateral pontine tegmentum (vlPAG/LPT), all of which regulate arousal
mechanisms. Emotional triggers from medial prefrontal cortex are
processed in amygdala but fail to raise hypothalamic Hcrt/Ox leaving
MCH activity unopposed. MCH then inhibits REM-­atonia suppres-
sion by vlPAG/LPT neurons leaving sublaterodorsal nucleus (gluta-
matergic) uninhibited, causing cataplectic atonia. In absence of Hcrt/
Ox, MCH disinhibits reward-­related REM automations contributing
to atonia.
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Conclusions: The dysregulation of wake-­active Hcrt/Ox and REM-­
active MCH neurons in NC underlines the neuroanatomic heteroge-
neity of LH. Further exploration of projections and neurotransmitters
Disclosure: Nothing to disclose.
P401 | Severity of oxygen desaturation in OSA
-­COPD overlap syndrome compared to OSA
alone
S. Frent1; R. Pleava2; C. Serban3; C. Ardelean4; I. Marincu5;
S. Mihaicuta1
1
Pulmonology; 2University of Medicine and Pharmacy Timisoara;
3
Functional Sciences, University of Medicine and Pharmacy Timisoara;
4
Cardioprevent Foundation; 5Infectious Diseases, University of
Medicine and Pharmacy Timisoara, Timisoara, Romania
Objectives/Introduction: Chronic obstructive pulmonary disease
(COPD) and obstructive sleep apnea syndrome (OSA) are both com-
mon conditions. Their comorbid association -­overlap syndrome
(OVS) has a prevalence of approximately 1% in the general popu-
lation and can result in clinically important nocturnal oxygen de-
saturation. We sought to compare oxygen saturation parameters in
patients with OVS versus OSA alone.
Methods: We enrolled in the study consecutive patients diagnosed
with OSA in our Sleep lab from 2005 to 2018. The diagnoses of OSA
and COPD were established according to standard diagnostic crite-
ria. Overnight sleep studies were performed in all patients and data
regarding apnea-­hypopnea index (AHI), oxygen desaturation index
(ODI), mean oxygen saturation, lowest oxygen saturation (%) and
duration of longest desaturation (sec.) were compared for patients
with OVS and OSA alone using Man-­Whitney test. Data distribution
was not normal and therefore we report the median values (IQR). A
p value < 0.05 was considered significant.
Results: 2173 OSA patients (71.2% males) were assessed, of whom
381 (17.5%) had OVS. Significant differences were found between
OVS and OSA alone groups regarding all evaluated parameters -­AHI:
44.2 (37.5) vs. 40.2 (36.9), p = 0.011; ODI: 30.7 (46.5) vs. 21.6 (39.3),
p < 0.001; mean saturation: 91.0 (6) vs. 94.0 (4), p < 0.001; lowest
oxygen saturation: 77.0 (17) vs. 80.0 (15), p < 0.001, and duration of
longest desaturation: 2.5 (15.4) vs. 1.3 (13.8), p = 0.013.
Conclusions: OVS patients have worse oxygen saturation param-
eters compared to patients with OSA alone. Identification of OVS
in OSA or COPD patients may have practical clinical relevance as
positive airway pressure therapy in OSA patients with COPD can
improve overnight oxygen saturation and survival.
Disclosure: Nothing to disclose.
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266 of 356       ABSTRACTS
P402 | Shared decision making in obstructive
sleep apnea. Does it happen?
T.C. Øverby1,2; P. Sutharshan3; P. Gulbrandsen4; T.
Dammen2; H. Hrubos-Strøm1,2
1
Division of Surgery, Department of Otolaryngology, Akershus
University Hospital, Lørenskog; 2Faculty of Medicine, Institute of Basic
Medical Sciences, Department of Behavioural Medicine, University
of Oslo, Oslo; 3Division of Psychiatry, Department of Substance
Abuse and Addiction, Akershus University Hospital, Åråsen; 4Faculty
of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo,
Norway
Objectives/Introduction: To examine shared decision making (SDM)
between patients diagnosed with moderate to severe obstructive
sleep apnea (OSA) and otolaryngology specialists or specialist candi-
dates. Scientific aims were:
1. To describe SDM at the time of sleep apnea diagnosis assessed by the
CollaboRATE questionnaire and the ‘Observer OPTION5’ rating scale.
2. To study the relation between SDM assessed by self-­report and
by a rating scale.
Methods: In total, 275 consecutive patients participated in this
baseline study of the Akershus Sleep Apnea (ASAP) clinical co-
hort. Patients with moderate to severe OSA and body mass index
(BMI) > 30 were available for video consultation at discharge.
Patients with newly diagnosed OSA could by protocol choose no
treatment, primary pharyngeal surgery (Friedman classification 1 or
2), primary weight reduction with a follow-­up consultation or posi-
tive airway pressure (PAP) treatment. Physicians had received com-
munication training and consented to be video filmed. ​Degree of
SDM was measured by the CollaboRATE self-­report questionnaire
and the ‘Observer OPTION5’ rating scale.
Results: Mean apnea hypopnea index (AHI) was 28.0 (SD 2.3), 28%
were female, mean age was 47.2 and mean body mass index (BMI)
30.3 (SD 0.4). 249 patients of the total sample and 17 of 18 video
filmed patients completed the questionnaire. Mean AHI among
video filmed patients (n = 18) was 36.2 (SD 6.8), 22% were female,
mean age was 47.8 and mean BMI 35.7 (SD 0.9). Four different doc-
tors were video filmed in 61%, 17%, 11% and 11% of the consulta-
tions respectively.
Mean CollaboRATE questionnaire score in the total sample was
26.5 (SD 0.30) and among video filmed patients 27.1 (SD 1.1). Mean
‘Observer OPTION5’ score 65.6 (SD 1.6), maximum value 80 and
minimum value 55. 17 of 18 patients were scheduled for PAP treat-
ment option, one patient primary weight reduction and nasal surgery
with a follow-­up consultation. Pearsons R was 0.09.
Conclusions: A high degree of SDM was found at discharge both
when assessed by the CollaboRATE and ‘Observer OPTION5’. All but
one video filmed patient chose treatment with PAP. However, there
was no relation between SDM assessed by self-­report and by a rat-
ing scale.
Disclosure: Nothing to disclose.
P403 | Sleep-­disordered breathing and sleep
quality: a Janus-­faced matter
J. Pinto1; M. van Zeller1,2; P. Amorim1,2; A. Pimentel1,2; P.
Dantas1; E. Eusébio1; J. Pipa1; A. Neves1; E. Santa Clara1; T.
Santiago1; P. Viana1; M. Drummond1,2
1
Pulmonology Department, Centro Hospitalar Universitário de São
João; 2Faculty of Medicine of Porto University, Porto, Portugal
Objectives/Introduction: The clinical presentation of sleep
disordered-­breathing (SDB) varies according to each disturbance,
nevertheless nocturnal symptoms are usually present transversally
and may impair sleep quality. Our aim was to compare the sleep qual-
ity of patients with and without SDB, and search for potential risk
factors for sleep problems.
Methods: All patients who underwent an appointment in the
Pulmonology Department from March 30 to April 30 of 2020 were
asked to participate in the survey. Sleep difficulties were assessed
using Jenkins Sleep Scale (JSS). Multiple logistic regression model-
ling was used to identify predictor variables for sleep problems.
Results: The study population consisted of 365 patients (mean age
63.9 years, 55.6% male, 50.1% with SDB). Patients with SDB were
more likely to be male (OR 1.73, p = 0.010) and to use hypnotics (OR
2.76, p  = 0.010). Also, SDB patients were more likely to report at
least one sleep difficulty (OR 1.69, p = 0.035), after adjustment for
gender and use of sleep-­inducing drugs. Specifically, SDB was asso-
ciated with reporting frequent awakenings during the night (OR 1.79,
p = 0.009). The presence of SDB under treatment had a protective
odds ratio for non-­restorative sleep complaints of higher magnitude
than having no SDB (OR 0.28, p = 0.003 versus OR 0.35, p = 0.017).
Hypnotics use was negatively associated to difficulties falling asleep
(OR 0.39, p = 0.044) but was positively related with non-­restorative
sleep (OR 2.17, p = 0.053). Among patients with SDB and under posi-
tive airway pressure (PAP) therapy, adherence was lower in those
who reported at least one sleep difficulty (median 96%, IQR 32%
versus median 100%, IQR 9; p = 0.020). PAP adherence showed a
moderate negative correlation with the JSS mean score (r = −0.313,
p < 0.001).
Conclusions: Overall, patients with SDB were more likely to report
sleep difficulties but reported less complaints of non-­restorative
sleep. Remarkably, patients with SDB who reported no sleep diffi-
culties presented a higher adherence to PAP therapy. Hence, an ef-
fective control of SDB greatly minimizes its symptoms and improve
sleep quality.
Disclosure: Nothing to disclose.
ABSTRACTS
P404 | Epidemiology of obstructive sleep
apnea in HIV patients: is there any association
with CD4 count
A. Najafi1; S. Akbarpour1; K. Sadeghniiat-Haghighi1; S.
Ghodrati1; Z. Navaiian2; P. Afsar Kazerooni3
1 ment procedures lasted for three nights. During the experimental
Occupational Sleep Research Center, Baharloo Hospital, Tehran
University of Medical Sciences; 2Shahid Beheshti University of Medical
Sciences, Tehran, Iran; 3Center for Disease Control (CDC), Ministry of
Health and Medical Education, Tehran, Tehran, Islamic Republic of Iran
Objectives/Introduction: OSA (obstructive sleep apnea) is a well-­
known disease characterized by upper airway collapse and subse-
quent intermittent hypoxemia during sleep. Limited information is
documented in HIV patients regarding OSA. In this study, we aimed
to assess the frequency of OSA and the association with CD4 count
in HIV positive patients.
Methods: Participants of study were recruited from Voluntary
Counselling and Testing (VCT) centers for HIV positive patients
in Tehran, Iran. Validated Persian version of Epworth Sleepiness
Scale (ESS) was used and the questions were asked by interviewers.
ESS > 10 was defined as high risk for OSA. The data was analyzed by
student independent T-­test and descriptive statistics.
Results: A total of 84 HIV positive patients were enrolled (17.9%(
n  = 15) was women). The Mean (SD) age and BMI of participants
were 39.8(9.6) years and 24(4.1) kg/m2, respectively. Of 84 partici-
pants, 21.4% (n = 18) was high risk for OSA and had ESS > 10. HIV
positive patients with normal ESS had clinically higher CD4 count
compared to high risk ones for OSA although statistical significant
relationship was not observed (Mean (SD) of CD4 in non-­OSA group:
511(278) vs. Mean (SD) of CD4 in OSA group: 409(243)).
Conclusions: Prevalence of OSA was almost high in patients with HIV
compared to general population despite low mean BMI of HIV posi-
tive patients. The novel probable association of OSA and CD4 count
could be considered a new era for interaction of sleep disorders
such as OSA and AIDS. Further research is needed for elucidation of
the interactions between OSA and AIDS, possible pathophysiologic
mechanisms and potential therapeutic approaches.
Disclosure: Nothing to disclose.
P405 | The protective effect of warmer colour
display of smartphone screen on sleep quality of
adults
W.Y. Wong
Hong Kong Polytechnic University, Hospital Authority, Hong Kong,
Hong Kong
Objectives/Introduction: This study investigated the effects of
bedtime mobile phone use of adults on sleep quality measured by
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commercially available sleep tracker, Fitbit Charge 3. It is the aim of
this study to identify whether using a warmer color display will alter
the effects of bedtime mobile phone use on sleep quality.
Methods: Thirty healthy adults (n = 30), 30–45 years old (Mean age,
M = 33.27 + 3.58), 23 females and 7 males, were recruited to take
part in this study. Within-­subject approach was adopted. The experi-
days, subjects were asked to wear the sleep tracker, Fitbit Charge 3,
to monitor their sleeping profile. Day 1 is the ‘adapting night’ for sub-
jects to get used to wearing the tracker to sleep. On Day 2, subjects
had needed to switch on the ‘Night Shift’ mode to the ‘warmer’ end
from 6 pm to 6am the next morning with full brightness. On Day 3,
the ‘Night Shift’ function was switched off while the screening was
kept at full brightness for the whole day. During Day 2 and Day 3,
subjects were asked to watch a 20–25-­minute-­long video and then
finish an online sleep diary (5–10 minutes long) after light out in their
own bed.
Results: It was found that subjects reported statistically significant
higher level of sleepiness before sleep (p  = 0.0035), had shorter
duration of light sleep (p = 0.0157), longer duration of Deep sleep
(p  = 0.0308), higher percentage of REM sleep (p  = 0.0398), higher
percentage of Deep sleep (p  = 0.0055), and lower percentage of
Light sleep (p = 0.0012) during the night using the Night Shift mode
(Day 2) than the night without Night Shift mode (Day 3).
Conclusions: Better sleep quality can be resulted from turning the
screen colour temperature to the warmer side using the Night Shift
mode in iOS platform.
Disclosure: Nothing to disclose.
P406 | Parent-­reported sleep onset latency is
associated with increased salivary cortisol level
among autism boys
M. Cao; J. Luo; B. Shi; J. Jing
Maternal and Child Health, Sun Yat-­sen University, Guangzhou, China
Objectives/Introduction: Autism children (ASD) showed impaired
sleep patterns relative to their typical developmental counterparts
(TD). Using a case-­control study, we explored the potential differ-
ence of sleep pattern and daily cortisol rhythm between school-­aged
ASD and TD boys, as well as the association between sleep param-
eters and cortisol level.
Methods: ASD boys (mean age = 9.1 years, n = 33) recruited from
Children and Adolescents Physical and Behavior Development
Center of Sun Yat-­sen University, TD (mean age = 9.9 years, n = 17)
boys were recruited from local primary school. Parents reported a
continuous 14-­day child sleep dairy, in the meantime, they were in-
structed to collect child`s salivary (4 times daily, including waking
in the morning, 30 min after waking, before lunch and before going
to bed at night) in two days during sleep dairy recording. Salivary
cortisol level was tested by enzyme-­linked immunoassay. Both sleep
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268 of 356       ABSTRACTS
dairy and cortisol level were analyzed by mixed liner model to elu-
cidate group effect and time effect. The relationship between sleep
onset latency and cortisol level was tested by liner regression model.
p < 0.05 was considered statistical significance.
Results: Relative to TD group, ASD showed delayed sleep onset la-
tency (28.89 ± 2.60 min vs. 20.74 ± 3.86 min, p = 0.087) and lower
night sleep efficiency (94.77 ± 0.44% vs. 96.37 ± 0.66%, p = 0.05).
In 24-­hour cortisol rhythm, ASD group had lower daily average sali-
vary cortisol level (0.19 ± 0.01 vs. 0.23 ± 0.02 ng/ml, p = 0.047) as
well as cortisol level before lunch (0.12 ± 0.02 vs. 0.18 ± 0.03 ng/ml,
p = 0.048) and before bedtime (0.05 ± 0.02 vs. 0.10 ± 0.02 ng/ml,
p = 0.03), compared with TD group. Cortisol level before bedtime is
associated with sleep onset latency (β=0.593, B = 95.16, p = 0.001,
95% confidential interval: 44.14–146.17) in ASD group, but not in
TD group (β=0.198, B = 41.69, p = 0.598, 95% CI: −102.67–186.05).
Conclusions: School-­aged ASD boys showed longer sleep onset la-
tency but lower full day cortisol level relative to TD boys. Longer
sleep onset latency is associated with higher before-­sleep cortisol
level among ASD but not TD. It is possible that ASD have unique
cortisol-­sleep onset regulation. A Larger sample size research is nec-
essary to confirm the result.
Disclosure: Nothing to disclose.
P407 | The misalignment of eating time
between workdays and free days is associated
with depressive mood
C.-S. Han1; J.-E. Yoon1; D.A. Oh1; D. Kim2; K.I. Yang3; M.K.
Chu4; S.-H. Park1; C.-H. Yun1
1
Seoul National University Bundang Hospital, Seongnam-­si,
Gyeonggi-­do; 2Chungnam National University Hospital, Daejeon-­si;
3
Soonchunhyang University College of Medicine, Cheonan Hospital,
4
Cheonan-­si; Severance Hospital, Yonsei University School of Medicine,
Seoul, Republic of Korea
Objectives/Introduction: The circadian rhythm has been reported
to regulate the sleep-­wake and metabolism cycles. As sleep pat-
tern changes between work and free days, the eating pattern also
changes between them. Therefore, we aimed to examine if the mis-
alignment of eating time is associated with depression
Methods: Korean Sleep Headache Study, a nationwide survey re-
garding sleep and headache in the representative sample of Korean
adults (age 19–92 years old), was performed from September to
December 2018. Total of 2,501 (age 47.9 ± 16.4 years old; female,
50.3%) gave informed consents and completed the survey. For this
study, we excluded 92 subjects working as shift workers and 44 sub-
jects with missing of any information. A total of 2365 subjects (age
48.0 ± 16.3 years old; male 49.3%) was included in the final analysis.
The misalignment of eating time is defined as the time difference
between the midpoint of eating window on workdays and on free
days. Participants were categorized 3 groups according to absolute
discrepancy of eating time (cutoff > 2 hours). Depression was de-
fined when the Patient Health Questionnaire (PHQ-­9) score was ≥ 5.
Results: Of the study participants, 19.6%, 70.8%, 9.5% had = 0 hours,
0 to ≤ 2 hours, and > 2 hours in misalignment of eating time, respec-
tively. Greater misalignment of eating time was significantly associ-
ated with an increase in the PHQ-­9 scores (2.7 ± 3.9 vs. 3.0 ± 3.7
vs. 3.5 ± 3.9, p = 0.046). The significant relation between misalign-
ment of eating time and depression was remained after adjusting
demographic factors, sleep habit, and psychologic factors. The
multivariable-­adjusted OR (95% CI) were 1.557 (1.062–2.281) for
presence of misalignment of eating time, whereas social jetlag was
not associated with depression. Additional chi-­square analysis had
been conducted in each social jetlag subgroup with or without pres-
ence of social jetlag for removing interaction between social eating
time and social jetlag. Depression had a high proportion in group
with misalignment of eating time additional to social jetlag (15.2%
vs. 24.0%, p = 0.016).
Conclusions: Misalignment of eating time may play a crucial role and
have a dominant circadian component in depression. In addition,
intervention for misalignment of eating time may be important to
consider in patients with depression.
Disclosure: Nothing to disclose.
P408 | The relationship between chronotype
and clinical symptoms and quality of life in the
euthymic state of the early-­onset major mood
disorder
J.Y. Seo1,2; C.-H. Cho3; Y. Lee1,2; S. Son4; S. Jeon1,2; Y.-M.
Ahn5; S.J. Kim6; J.H. Baek7; T.H. Ha8; E. Moon9; D.Y. Park10;
B. Cha11; H.-J. Kang12; H. An4; H.-J. Lee1,2
1
Psychiatry, Korea University College of Medicine; 2Chronobiology
Institute, Korea University, Seoul; 3Psychiatry, Chungnam National
University Hospital, Daejeon; 4Biostatistics, Korea University College of
Medicine; 5Psychiatry, Seoul National University College of Medicine;
6
Psychiatry, Yonsei University College of Medicine; 7Psychiatry,
Samsung Medical Center, Seoul; 8Psychiatry, Seoul National University
Bundang Hospital, Seongnam; 9Psychiatry, Busan National University
10
School of Medicine, Busan; Psychiatry, National Center for Mental
11
Health, Seoul; Psychiatry, Gyeongsang National University College of
12
Medicine, Jinju; Psychiatry, Chonnam National University College of
Medicine, Gwangju, Republic of Korea
Objectives/Introduction: Chronotype refers to personal differences
related to circadian rhythm, daily activity pattern and sleep-­wake
cycle. Evening chronotype is known to be associated with more se-
vere moods and anxiety symptoms, while morning chronotype is
known to be associated with better quality of life. This study aims
to examine the how chronotype is differentially related with mood
symptoms, anxiety, and quality of life in early-­onset major depressive
disorder (MDD), bipolar I disorder (BDI) and bipolar II disorder (BDII).
ABSTRACTS
Methods: A total of 379 participants were included in the Mood
Disorder Cohort Research Consortium (MDCRC) study, a multi-
center prospective observational cohort study investigating early-­
onset mood disorders in South Korea. We examined depressive
symptoms (QIDS, MADRS), mania related symptoms (YMRS, MDQ,
HCL-­32), anxiety symptoms (BAI), and quality of life (WHOQOL) ac-
cording to the chronotype (CSM) of all subjects in euthymic state.
Logistic regression analysis was used to calculate the odds ratios
(ORs) and confidence intervals (CIs) of the subjects’ mood question-
naire, anxiety and quality of life score by the CSM score.
Results: Higher CSM score was associated with fewer symptoms
of depression [QIDS, MDD: −0.332 (95% CI −0.503 -­ −0.160), BDI:
−0.210 (95% CI −0.389 -­ −0.031), BDII: −0.332 (95% CI −0.503
-­ −0.160); MADRS, MDD: −0.436 (95% CI −0.663 -­ −0.210), BDI:
−0.240 (95% CI −0.477 -­ −0.003), BDII: −0.298 (95% CI −0.527 -­
−0.068)]. Higher CSM score was associated with better quality of
life [WHOQOL, MDD: 0.695 (95% CI 0.359–1.031), BDI: 1.059 (95%
CI 0.707–1.410), BDII: 0.735 (95% CI 0.394–1.076)] in euthymic
mood disorder patients. However, there was no significant associa-
tion between chronotype and manic and anxiety symptoms in those
subjects.
Conclusions: These findings indicate that morning chronotype sub-
jects among mood disorder patients are less depressive and having a
better quality of life in the euthymic state.
Disclosure: Nothing to disclose.
P409 | The relationship between cortical
arousal and subjective insomnia symptoms in
primary insomniacs
S. Yu; Y. Lee; B. Kim; S. Choi
Duksung Women's University, Seoul, Republic of Korea
Objectives/Introduction: Insomnia is one of the most frequent
mental problems in these days. According to the previous re-
searches, hyperarousal such as high proportion of high frequency
electroencephalography(EEG) around sleep onset or Non-­rapid eye
movement sleep(NREM sleep). Also, Insomniacs shows hyperarousal
while they are waking, so this characteristic is known to be 24 hours
hyperarousal. However, there is few research that how waking EEG
is related to the insomniacs´ symptoms. Therefore, this research in-
vestigates the relationship of waking EEG(beta) and insomnia symp-
tom focused on insomnia severity items(ISI) and subjective total
sleep time(TST).
Methods: 26 participants having primary insomnia was included in
analysis(male = 10, female = 16). Insomnia severity was measured
by Korean version of Insomnia severity index and subjective total
sleep time was measured by sleep diary. EEG were measured from
19 area (FP1, F3, F7, Fz, FP2, F4, F8, T3, C3, Cz, T4, C4, T5, P3, O1,
Pz T6, P4, O2). The 19 electrodes were averaged into 9 regions: the
left anterior (Fp1, F3, F7), midline anterior (Fz), right anterior (Fp2,
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F4, F8). Left central (T3, C3), midline central (Cz), right central (T4,
C4), left posterior (T5, P3, O1), midline posterior (Pz), and right pos-
terior (T6, P4, O2) regions. Power spectra were computed for the
following frequency bands:Beta 2(15–18 Hz), Beta 3(18–25 Hz),
High beta(25–30 Hz). Demographic information and spearman cor-
relation coefficient between EEG beta and insomnia symptoms were
calculated by SPSS v22.
Results: Each spearman correlation between High beta, insom-
nia severity index and subjective total sleep time were conducted.
Insomnia severity index and relative high beta power in right pos-
terior region showed positive correlation(r = 0.423, p = 0.031). Also,
subjective total sleep power showed negative correlationship with
relative high beta power in midline anterior(r = −418, p = 0.034), left
central(r  =  −0.403, p  =  0.041), midline central(−0.408, p  = 0.013),
midline posterior region(r = −0.448, p = 0.022).
Conclusions: The result shows the possibility that insomniacs cannot
reduce their waking Beta power, which means cortical hyperarousal,
so, they can´t take deeper sleep and perceive they didn´s sleep for
long time enough. Also, it means waking EEG could be a biomarker
to distinguish primary insomnia from other insomnia patient with
co-­morbid disorder and it could be a target for reducing subjective
insomnia symptoms.
Disclosure: Nothing to disclose.
P410 | Development and psychometric
properties of a short form of the Sleep-­related
Behaviours Questionnaire
A. Ubara1,2,3; I. Okajima4; N. Machida5; H. Kadotani2; S.-I.
Ishikawa6
1
Graduate School of Psychology, Doshisha University, Kyotanabe-­
shi; 2Department of Sleep and Behavioral Sciences, Shiga University
of Medical Science Hospital, Otsu-­shi; 3Research Fellow, JSPS;
4
Department of Psychological Counseling, Faculty of Humanities,
Tokyo Kasei University, Tokyo; 5Bellflower, Psychological Counseling
Center, Neyagawa-­shi; 6Faculty of Psychology, Doshisha University,
Kyotanabe-­shi, Japan
Objectives/Introduction: Sleep-­
related Behaviours Questionnaire
(SRBQ) has been developed to measure sleep-­related safety behav-
iours in insomnia (Ree & Harvey, 2004). Safety behaviours consist of
both nocturnal and daytime maladaptive acts, which mainly aim to
cope with the fear of not sleeping and the consequences of disturbed
sleep. Previous studies of CBT-­I suggested that the change of safety
behaviours mediates the improvement of insomnia (Harvey et al., 2017).
Although the scale could be useful to detect therapeutic mechanism of
CBT-­I, the Japanese version of the scale is not development. This study
aims to develop a short form of the SRBQ by item response theory (IRT).
Methods: Participants were 230 university students (M  =  20.56,
SD  =  0.98), 447 adults (20s~60s), and 49 patients (M  =  55.29,
SD  =  22.72). They completed a) demographic data, b) the Japanese
 |
270 of 356       ABSTRACTS
version of the SRBQ, c) the Athene Insomnia Scale (AIS), d) the Patient
Health Questionnaire (PHQ-­9). This study was approved by the Ethics
Committee of the Department of Psychology, Doshisha University.
Results: As 17 items were excluded by item analysis, 15 items were
analyzed by categorical factor analysis. After 2 items were removed
due to low commonality (below 1.6), the test information functions of
the 13 items peaked around θ = 1.5 to 2.5. The internal consistencies of
the adult-­, student-­, and patient-­groups were α = 0.84, 0.82, and 0.88,
respectively. ANOVA indicated significant difference for age (old, mid-
dle aged, and young) in SRBQ, F (2, 481) = 11.82, p < 0.001, but not
for group, F (1, 481) = 0.008, p = 0.928. Whereas SRBQ was strongly
associated with AIS (r = 0.71) and PHQ-­9 (r = 0.71) in the patient group,
the correlation coefficients were moderate with AIS, r = 0.53, 0.53, and
PHQ-­9, r = 0.51, 0.46 for students and adults, respectively.
Conclusions: The findings showed that the short form of SRBQ has
high reliability and validity. In particular, the results of the test in-
formation function show a higher accuracy for subjects with higher
characteristic values. Therefore, the scale could measure safety be-
haviours more adequately in those who strongly show the behaviours.
Disclosure: Nothing to disclose.
P411 | Updated version of the Hockey-­stick
program to estimate melatonin onset and offset
K.V. Danilenko1; E.G. Verevkin2
1 Objectives/Introduction: The importance of sleep health is receiv-
Institute of Physiology and Basic Medicine; 2Institute of Internal and
Preventive Medicine, Novosibirsk, Russian Federation
Objectives/Introduction: The hockey-­
stick program was first
launched in 2014 (Danilenko et al., 2014) to approximate the onset
of secretion of pineal melatonin (the best indicator of internal cir-
cadian time in humans) from the time series of evening salivary (or
blood) melatonin values. The program is written in Delphi and runs in
Windows (executable file). The program´s interactive algorithm uses
a pairwise linear-­parabolic function (looking like a hockey stick) to
find the inflection point -­the transition between the straight line and
parabola branch, which is the decision (Russian patent #2013661154,
29.11.2013). In addition, the program provides additional melatonin
timing measures – ‘Threshold crossing time’ and ‘2SD time’ (to meet
requirements of some users). The method has already been used in
more than 10 studies published by independent centers. Since its
first publication, ways to improve the program have been identified.
Methods: The first version of the program was upgraded to the sec-
ond version:
-­in addition to melatonin onset, it can measure melatonin offset;
-­the left and right borders of the area of interest (where the inflec-
tion point is supposedly located) are now modifiable (realized in ver-
sion 1.6 already);
-­corrected decision in the case when only one melatonin value con-
stitutes the dynamic part;
-­elimination of some previously identified bugs.
Results: The program was tested on 92 salivary melatonin profiles
obtained from 46 subjects in summer and winter (previously ana-
lyzed using version 1.6; Danilenko et al., 2019).
The elaborated version satisfactorily worked both for the melatonin
onset and offset (according to the expert evaluation of the authors)
and revealed no bugs during the testing.
Conclusions: The second (and probably the last) version of the
hockey-­
stick program can measure not only melatonin evening
onset, but also morning offset, it is more interactive in search and
devoid of some bugs of previous versions, which was confirmed dur-
ing testing. The Hockey-­stick v2.4 is freely accessible from https://
cloud.mail.ru/publi​
c/E3Dd/5iw38​
DSYy (launched in January, 15,
2020).
Disclosure: Melatonin profiles for testing were taken from a study
supported by the Russian Foundation for the Humanities grant #15-­
36-­01023 to KVD (2015-­2016).
P412 | Sleep health promotion interventions
and their effectiveness: an umbrella review
U. Albakri1,2; E. Drotos1; R. Meertens1
1
Health Promotion, Maastricht University, Maastricht, The
Netherlands; 2Public Health, Albaha University, Albaha, Saudi Arabia
ing increasing attention in public health. This review of reviews sys-
tematically summarizes the scope and effectiveness of sleep health
promotion interventions in healthy populations. The aim of this um-
brella review is to determine what non-­pharmacological sleep health
interventions have been implemented, in what target groups and
settings, and how effective they are in improving sleep quality and
duration.
Methods: Comprehensive searches were conducted in five elec-
tronic databases (January 1975 to February 2019), yielding 6240
records. Thirty-­three articles were selected, which met the eligibil-
ity criteria: 1) systematic review or meta-­analysis 2) reviewing sleep
health promotion interventions 3) in primarily healthy populations.
Two reviewers independently screened for inclusion, extracted data,
and assessed review quality. This umbrella review was registered
with PROSPERO (CRD42019126291).
Results: Target populations ranged across all age groups, from infant
to elderly participants, though most targeted adults, including spe-
cialized groups such as shift workers, pregnant women, and athletes.
Settings also varied, with interventions occurring in home, work-
place, community, healthcare, school, and laboratory settings. Ten
intervention types were defined and their effectiveness examined.
Later school start times demonstrated significant improvement in
sleep duration in school-­aged children. In infants, substantial evi-
dence exists for behavior change methods (behavioral techniques
carried out by outside helpers, such as routine management) in im-
proving sleep quality across multiple reviews. Mind-­body exercises,
ABSTRACTS
like Tai chi, also demonstrated substantial impacts on sleep dura-
tion and quality across multiple reviews. Relaxation techniques, aro-
matherapy, massage, psychotherapy, environmental interventions,
physical exercise, and sleep education demonstrated some promis-
ing impacts on sleep, but with less consistent evidence.
Conclusions: This umbrella review is the first to provide an over-
all overview of the strategies used in the rapidly evolving field of
sleep health promotion, and gives insight into the populations tar-
geted and settings. There is substantial evidence demonstrating the
effectiveness of later school start times, behavior change methods,
and mind-­body exercise. Results were limited by high heterogeneity
between studies, mixed results and variable review quality. Further
research should aim to standardize sleep-­related outcome measures
and intervention types while using rigorous study designs.
Disclosure: Nothing to disclose.
P413 | Newborns’ sleep during auditory
stimulation -­the role of perinatal memory and
stimulus familiarity
M. Schabus1; A. Lang1; P. Ott1,2; R. delGiudice1,3
1
Laboratory for Sleep, Cognition and Consciousness Research,
University of Salzburg; 2ITS Informationstechnik & System-­
Management, Salzburg University of Applied Sciences, Salzburg,
Austria; 3Department of Health Sciences, Università degli Studi di
Milano, Milan, Italy
Objectives/Introduction: We examined the effect of auditory stim-
ulation and prenatal learning in 34 healthy newborns.
Methods: For the latter, we presented the fetuses with a spoken
nursery rhyme in the mother's voice and re-­exposed newborns to
this familiar as well as to an unfamiliar rhyme two and five weeks
after birth. Infants’ sleep-­wake state as well as heart rate activity and
hdEEG during stimulation were analyzed.
Results: Our results demonstrate a calming effect of auditory stim-
ulation in infants who were prenatally ‘familiarised’ to that stimu-
lation, as evidenced by lower heart rates and less waking states.
Interestingly infants also slept more and demonstrated stronger
speech-­to-­brain coupling when hearing the maternal voice or being
presented with a new rhyme.
Conclusions: The results suggest ‘fetal programming’ at multiple lev-
els and point to the specific significance of the maternal voice as
well as to the special relevance of unfamiliar speech material at birth.
Disclosure: Nothing to disclose.
|
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P414 | Altered pharmacokinetics of sodium
oxybate in narcolepsy type 1 patients after
gastric bypass surgery
M. Moresco1; F. Busardò2; S. Mohamed3; A. Perrone3; F.
Pizza1,4; M. Contin1; R. Riva1; G. Plazzi1,4
1
IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna;
2
Department of Excellence of Biomedical Sciences and Public Health,
University ‘Politecnica delle Marche’ of Ancona, Ancona; 3IRCCS
Istituto delle Scienze Neurologiche, Ospedale Bellaria; 4Department of
Biomedical and Neuromotor Sciences, University of Bologna, Bologna,
Italy
Objectives/Introduction: we investigated pharmacokinetics of so-
dium oxybate (SO; Xyrem®) in two narcolepsy type 1 (NT1) patients
developing side effects after gastric bypass surgery (enuresis, morn-
ing nausea and dizziness).
Methods: four NT1 patients (2 underwent gastric bypass and 2 were
controls) on SO stable dose for at least 12 months. Each subject took
two 56 mg/kg doses of SO 4 hours apart. SO concentrations were
determined from blood samples [1] at 0, 0.75, 1.5, 2, 3, 4 hours fol-
lowing first dose, and at 4.75, 5.5, 6.5, 8, 9 hours after the second.
Results: mean (±SD) maximum SO (gamma-­
hydroxybutyric acid)
blood concentrations (Cmax) were 79.4 ± 7.5 µg/ml and 44.6 ± 5.6 µg/
ml after first dose; 127.3 ± 20.2 µg/ml and 79.3 ± 0.9 µg/ml after
the second dose for patients with gastric bypass and controls, re-
spectively. Residual morning SO levels at 8 hours from the first dose
were 58.6 ± 18.8 µg/ml in gastric resection patients vs 9.1 ± 7.3 µg/
ml in controls. Maximum time needed to reach the first dose Cmax
was 1.5 h in gastric bypass patients and 0.75 h in controls. Mean
area under the plasma concentration-­
time curve (AUC0-9 h) was
doubled in patients with gastric bypass vs controls: 656.6 ± 18.9 vs
275.7 ± 31.1 [(µg/ml) x h] respectively.
Conclusions: gastrointestinal alterations particularly impaired gastric
emptying and increased intestinal transit time [2], which might result
in prolonged exposure of the drug to intestinal mucosa accounting for
the higher extent of SO absorption and explaining the occurrence of
the side effects observed in our patients with gastric bypass.
Disclosure: Nothing to disclose.
P415 | Obstructive sleep apnea -­about the
differences between male and female patients
J. Costa1; R. Natal1; F. Ramalho Fernandes1,2; J.M. Silva1,2; A.
Tavares1,2
1
Pulmonology Department, 2Sleep Disorder Clinic, Unidade Local de
Saúde da Guarda, E.P.E., Guarda, Portugal
Objectives/Introduction: Obstructive Sleep Apnea (OSA) is a sleep
disorder defined by repetitive episodes of partial or complete upper
 |
272 of 356       ABSTRACTS
airway collapse during sleep, leading to intermittent hypoxia and mi-
croarousals. Its prevalence in men is 4% and 2% in women, with a
male-­female ratio ranging from 3:1 to 5:1. The mechanisms under-
lying the differences in prevalence between men and women still
remain to be fully understood. Our goal was to investigate and com-
pare anthropometric and polysomnographic differences between
male and female patients with OSA followed at our hospital's Sleep
Disorders clinic.
Methods: This study included 82 patients diagnosed with OSA after
performing home respiratory polygraphy during 2019. Body mass
index (BMI), neck circumference (NC), apnea-­hypopnea index (AHI),
oxygen desaturation index (ODI), mean oxygen saturation and sleep
time with oxygen saturation lower than 90% were compared.
Results: Most patients were male (n = 65; 79.3%) and male-­female
ratio was 3.8:1. Age difference between both groups was not statis-
tically significant (p > 0.05). From our total sample, 37.8% patients
had mild, 28% moderate and 34.1% severe OSA. Most female pa-
tients (58%) had mild OSA, while most male patients had moderate
to severe OSA (67.7%). BMI was higher in male patients, with no sta-
tistical significance. However, NC showed to be significantly higher
in men (41.8 ± 0.4 cm vs 35.1 ± 0.5 cm; p < 0.001) than women. AHI
and ODI were also higher in male patients: 32.2 ± 3.3 vs 15.7 ± 2.3
(p = 0.012) and 28.3 ± 3.2 vs 13.3 ± 1.8 (p = 0.023), respectively.
Conclusions: Despite the small number of patients, our sample
shows a male-­female ratio similar to what has been previously re-
ported. The reason for the higher prevalence and severity of OSA
in men (in our sample represented by higher AHI and ODI) most
likely reflects gender differences in both structure and physiologi-
cal behavior of the upper airway, craniofacial morphology and fat
deposition pattern. It is known that men have a greater tendency
for android fat distribution resulting in larger neck size, which may
contribute to the increased prevalence of OSA in men.
Disclosure: Nothing to disclose.
P416 | Sleep problems across a lifespan of
children, adolescents and adults with autism
spectrum disorder and intellectual disability at a
glance
P. Ballester1; M.J. Martinez Madrid2; T. Canet3; A.L.
Richdale 4; A.M. Peiro5
1
Department of Pharmacology, Pediatrics and Organic Chemistry, Miguel
Hernández de Elche University, Elche; 2Chronobiology Lab, College of
Biology, Department of Physiology, University of Murcia, IUIE, IMIB-­
Arrixaca, Murcia University, Murcia; 3Sleep Unit, Health Department
Alicante-­General Hospital, Alicante, Spain; 4Olga Tennison Autism
Research, Melbourne, VIC, Australia; 5Clinical Pharmacology Unit,
Health Department Alicante -­General Hospital, Alicante, Spain
Objectives/Introduction: Sleep and sleep problems (SP) are recog-
nized as common comorbid condition in autism spectrum disorder
(ASD). They can affect core symptoms plus their mental and physical
health. Even more, these could be worse when Intellectual Disability
(ID) is associated. Up to present, sleep-­wake transitions use to be
evaluated in independent age groups and due to subjective tools as
diaries. Our aim was to assess these circadian rhythms by ambula-
tory circadian monitoring (ACM) across their lifespan.
Methods: An observational prospective study was conducted in
127 autistic individuals with ID (ASDID), classified into three differ-
ent range ages [n = 14 [5–20], n = 66 [21–30], n = 47 [31–60] years
old]). Sleep was analyzed due ACM recording regular variables and
circadian rhythms (wrist temperature, motor activity, body position,
sleep, TAP and light intensity).
Results: All ASDIDindividuals presented low sleep efficiency, in-
creased sleep latency as well as increased waking time due to awak-
enings at night compared to controls, independently from age. Total
time in bed increases significantly with age due to a high number and
longer time of night's awakenings (62 ± 46; 74 ± 56; 136 ± 87 min, re-
spectively, p value 0.003). Related to sleep/wake cycle, a pattern of
phase advance disorder was found according to the central hour of
sleep at night (3:23 ± 1:04; 1:33 ± 4:24; 1:07 ± 1:20 hh:mm, respec-
tively, p-­value 0.0004). Older [31–60 years old] subjects associated
a more frequent daily sedentary behavior and increased nocturnal
activity compared to controls.
Conclusions: This is first time that a study shows SP evolution,
across ASDID lifespan, with worsening ACM parameters related to
age. Relationship with intellectual ability or aging process should
be further studied. Improving knowledge of sleep patterns in ASD
might help to design targeted interventions to improve their func-
tioning and life quality.
Disclosure: Nothing to disclose.
P418 | Individualized thresholds in sleep
spindle detection
M. Lucchini1; L. Fiorillo1; S. Scafa2; C. Roth3; A. Vancheri4; F.
Faraci1
1
DTI, SUPSI, Manno, Switzerland; 2Department of Electronics and
Telecommunications, Politecnico di Torino, Torino, Italy; 3Neurology
Department Inselspital, University Hospital Bern, Bern; 4DTI, SUSPI,
Manno, Switzerland
Objectives/Introduction: Spindle identification is essential dur-
ing sleep scoring procedure, as they are a hallmark of sleep stage
NREM2. Various automated spindle detection methods have been
proposed to reduce subjective biases, save time and increase reli-
ability and objectivity. Spindle density, mean oscillation frequency,
amplitude and duration do appear stable over time in the same night
for the same subject, but may vary considerably between subjects.
Therefore, after investigating the effectiveness of an approach
based on thresholds, we propose a personalization procedure based
both on frequency and amplitude criteria.
ABSTRACTS
Methods: We test our approach on YASA, a state-­of-­the-­art spindle
identification algorithm. Firstly the broadband filtered EEG signals
(0.3–30 Hz; EEGbf) and the sigma band passed filtered (11–16 Hz;
EEGs) are calculated. Then the algorithm detects a spindle when two
out of the following three quantities exceed a threshold: relative
power of EEGs to EEGbf, RMS of EEGs and the correlation between
EEGs and EEGbf. We extract specific time-­frequency characteristics
from a set of input spindles (IS) of the same subject, annotated by a
human expert scorer. Then we adapt the algorithm with a thresh-
old individualization, and a minimum IS number. We call I-­YASA
(Individualized YASA) the present adaptation of YASA. The analysis
are performed on the DREAMS database (n = 8, spindles = 607) and
on a whole night PSG (n = 1, spindles = 838).
Results: On the DREAMS database with a confidence level of 95% as
threshold and IS = 5, the overall increase of F1 score is 0.19 (pval < <
0.01). I-­YASA with an input set of only five spindles, reached a better
F1 for all the subjects excepted from one, where the IS number has
to be increased to ten. On the whole night PSG the optimal number
of IS was 20, due to overnight variation.
Conclusions: The results highlight that individualization leads to a
more accurate automated scoring procedure. Further work would
have to validate these results on a larger dataset and should conduct
an extensive study of the relation among the parameters themselves.
Disclosure: Nothing to disclose.
P419 | Prevalence and dynamic of sleep
disturbances over 30 years in Russia/Siberia:
1988-­2018 years
V. Gafarov1,2; E. Gromova1; D. Panov1; I. Gagulin1; E.
Krymov1; A. Gafarova1
1
Research Institute of Internal and Preventive Medicine, branch of
Institute of Cytology and Genetics SB RAS; 2Collaborative Laboratory
of Cardiovascular Disease Epidemiology, Novosibirsk, Russian
Federation
Objectives/Introduction: To study the prevalence and long-­term
trends of sleep disturbances over a 30-­year observation in popula-
tion of 25–64 years in Novosibirsk.
Methods: Representative samples of general population were ex-
amined in 1994–95, 2003–2005, 2013–2016, 2015–2018 according
to standard methods adopted in epidemiology and included in the
MONICA-­MOPSY program. A total of 2650 men and 3113 women
aged 25–64 years were examined. Respondents were asked: ‘How
do you sleep?’ The following answers were suggested: ‘very good’,
‘good’, ‘satisfactory’, ‘bad’, ‘very bad’. The answer options ‘bad’ and
‘very bad’ were regarded as sleep disturbance. This survey per-
formed in frame budgetary issue # АААА-­А17-­117112850280-­2.
Results: The highest prevalence of sleep disorders has been estab-
lished in older age group of women -­24.9% (p < 0.001). The growth of
sleep disorders is observed with age. The lowest prevalence of sleep
|
      273 of 356
disorders was in 25–34 years age group of males (4.3%, p < 0.01) and
females (5.7%, p < 0.001). The highest prevalence of sleep disorders
was in the group of 55–64 years old in men (19.7%, p < 0.001) and
women (24.9%, p < 0.001). Concerning the time trends the highest
rates of sleep disturbance were observed in all age groups in 1988–
89 yy; a decrease in the level of sleep disturbances was in 1994–95
yy; by the 2000s an increase in sleep disturbances was in all age
groups with the exception of men aged 45–54 years.
Conclusions: The presented facts which are the result of 30 years
of epidemiological studies conducted in Novosibirsk clearly dem-
onstrate not only the prevalence of sleep disorders in working-­age
population but also its unfavorable trends.
Disclosure: Nothing to disclose.
P420 | Excessive daytime sleepiness in health
professionals at an Universitary Hospital
M. Pereira1; M. Barata2; D. França1; E. Leite1; J. Carvalho1; P.
Pinto1; C. Bárbara1
1
Centro Hospitalar Universitário Lisboa Norte, 2Hospital Garcia de
Orta, Lisboa, Portugal
Objectives/Introduction: Disturbance of the sleep/wake cycle
caused by shift work and night work negatively influences both
the quantity and quality of sleep. These changes may cause, among
other symptoms, drowsiness during waking periods.
The aim of the study was to analyse the levels of daytime sleepiness
in health professionals at our Hospital who work in shifts (with night
hours) and with fixed hours (during the day).
Methods: Cross-­sectional study with application of the Epworth
Sleepiness Scale (ESS) was applied to a group of professionals ob-
served at the Occupational Health Service of the Hospital in 1 month.
The statistical analysis of data was performed using SPSS and chi-­
square test. A significance level of 5% was accepted.
Results: 96 professionals were included in the study, most of them
female (n = 72; 75%). Fifty-­three (55.2%) worked in shifts with night
hours and 43 (44.8%) only during day. The group of profession-
als with night work had more excessive daytime sleepiness (ESS
score > 10) compared to the group of workers with exclusive day-
time hours (45.3% vs 32.6%; p = 0.205). In the group of profession-
als who work in shifts, the STOP-­BANG average was 2.1 and the
classification in the Pittsburgh questionnaire was 7.2; in the other
group with daytime hours it was 1.8 and 6.7, respectively. Most pro-
fessionals drink coffee daily (n  = 81; 84.4%), 48 of whom work in
shifts (59.3%). There was a greater number of shift workers drinking
more than 2 coffees per day compared to day workers (n = 22 vs 9
respectively; p = 0.129).
Among professionals with severe levels of daytime sleepiness
(ESS > 16), 88,9% (n = 8) worked in shifts and 11,1%, (n = 1) worked
only during the day, with a statistically significant correlation be-
tween the two variables (p = 0.044).
 |
274 of 356       ABSTRACTS
Conclusions: This study showed a high prevalence of daytime
sleepiness in health professionals who work at night. The presence
of higher levels of drowsiness in professionals who work at night
may help to corroborate the hypothesis that daytime rest in these
professionals is not equivalent to a regular nighttime sleep pattern.
Moreover, this situation could also negatively influence daily profes-
sional performance.
Disclosure: Nothing to disclose.
P421 | Digital cognitive behavioural therapy for
insomnia: gender differences in dropout rates
L. Retzer1,2; R. Reindl2; S. Zauter2; K. Richter1,2,3
1 Sleep Support Service each complete a monthly sleep study scoring ex-
University Clinic for Psychiatry and Psychotherapy, Paracelsus Medical
2 ercise for quality control purposes. Every third month, the assignment
University Nürnberg; Institute for E-­Counselling, Nuremberg Tech,
Nuremberg, Germany; 3Faculty for Medicine, University Goce Delcev
Stip, Stip, North Macedonia
Objectives/Introduction: Shift work is associated with a number of
health complaints, most prominently sleep disorders. Tailored ap-
proaches to treatment for this population are rare. We thus imple-
mented an online platform to provide digital cognitive behavioural
therapy for insomnia (dCBT-­I) specifically for shift workers. Dropout
rates in dCBT-­I trials are relatively high, typically ranging around 35%
to 50%. The literature suggests that women prefer face-­to-­face con-
tact in psychotherapy settings. Our objective was to analyse gender
differences between dropouts and completers in our trial. We hy-
pothesized that a higher percentage of women would drop out of the
study compared to men.
Methods: We performed post-­hoc analysis (Chi-­Square-­and t-­tests)
on the data from our 4-­week dCBT-­I trial. Specifically, we compared
dropout rates and time of dropout by gender.
Results: The trial was initiated by n = 50 participants (13 female/37
male), of which 56% did not complete the program. Dropout rates
were significantly higher in women (77%) than men (49%; p = 0.034).
Every week of the trial between 6% and 16% of men and between
15% and 23% of women dropped out. There were no significant
gender differences regarding time of dropout or other sample char-
acteristics, such as total sleep time, symptom severity, age, or em-
ployment (all p values > 0.20).
Conclusions: Even though they suffer from just as many symptoms
of insomnia, female shift workers may be more prone to drop out of
dCBT-­I programs than their male counterparts. This highlights the
need for additional research to improve engagement and adherence
in dCBT-­I, specifically for women. The relatively small sample size
limits the transferability of these results.
Disclosure: Nothing to disclose.
P422 | Quality control of polysomnographic
scoring in a clinical sleep physiologist team
H. Engleman; N.F. Cachada; S. Hacking; L. Irwin; S. Martin;
N. Derashri
Philips Sleep Support Service, Philips Respironics UKI, Chichester,
United Kingdom
Objectives/Introduction: To apply an external gold standard for pol-
ysomnographic scoring in a team of sleep physiologists, in order to
align scoring practice, maintain learning and to assure quality control
of scoring output.
Methods: The four sleep physiologist scorers in Philips Respironics’ UK
is an American Association for Sleep Medicine (AASM) inter-­scorer reli-
ability (ISR) exercise. The ISR exercise comprises sleep staging of 200 ep-
ochs, with scoring also of respiratory events, arousals and periodic limb
movements. Scoring results are expressed as an overall percentage cor-
rect score against the AASM scoring by a panel of gold-­standard scorers.
A threshold of ≥ 85% correct is considered acceptable. In between ISR ex-
ercises, monthly internal scoring exercises of polygraphy are performed
(not reported here). Below-­standard scoring performances are addressed
by group discussion and reviewing the relevant AASM training video.
Results: The AASM ISR exercise has been completed 11 times in the
33 months since this was commenced. Average agreement of our
team with the gold-­standard over the time-­series was: 82%, 93%,
94%, 95%, 91%, 93%, 91%, 95%, 96%, 94% and 92%. Scoring team's
ISR scores were higher than the threshold of 85% in all but the first
ISR exercise, and overall significantly higher than this threshold
(Wilcoxon test, p < 0.001). There was a non-­significant trend for im-
proved team scores over time (Mann-­Kendall trend: p = 0.12).
Conclusions: Use of the ISR assisted a clinical sleep scoring team to
improve agreement with an external gold-­standard, to avoid scoring
‘drift’ within the team over time, to perform and maintain learning, and
to regularly exercise the full range of polysomnographic scoring skills.
Disclosure: All authors are employees of Philips Respironics UKI.
P423 | Sleep, the overlooked factor in the
management of T2D
S. Khodabakhsh1; A. Searle2; A. Papadaki1; L. Johnson1; C.
England1,2
1
Centre for Exercise, Nutrition and Health Sciences, School for Policy
Studies, University of Bristol; 2National Institute for Health Research
Bristol Biomedical Research Centre, University Hospitals Bristol NHS
Foundation Trust and University of Bristol, Bristol, UK
Objectives/Introduction: Poor sleep quality and sub-­optimal sleep
duration have been shown to be associated with poor glycaemic
ABSTRACTS
control in people with Type 2 Diabetes (T2D). However, there is a
gap in diabetes health care guidelines regarding the importance of
sleep. Furthermore, the perceptions of people with T2D regarding
this matter, as well as the factors affecting their sleep, have not been
explored. Therefore, the perceptions of patients with T2D were ex-
plored regarding: i) the factors affecting their sleep and ii) the impor-
tance of sleep in controlling T2D.
Methods: A qualitative study using 3 focus groups was conducted.
Purposive sampling was applied to include people with T2D who did
not use sleep medications and had no history of depression, anxiety,
and sleep apnoea. Topic items explored participants’ perceptions of
their sleep, factors affecting sleep and the importance of sleep in
controlling T2D. Audio recordings were transcribed verbatim and
analysed using Thematic Analysis. To improve the study validity
data coding and interpretation was carried out by three independent
researchers.
Results: Twelve people (25% female) with age range of 55–72 years
were involved in our study. Interrupted sleep was a long-­lasting
problem amongst the participants. Participants perceived environ-
mental factors (noise and light pollution), familial factors (children
and partners) and T2D complications (thirst and urination) to pre-
vent them from good sleep while retirement was perceived to lead
to better sleep; participants believed this to be due to reduced work-­
related concerns. Participants perceived that the advice given by
GPs/Diabetes nurses focused on diet and physical activity, but the
importance of sleep was never discussed. Moreover, participants
were not aware of the link between sleep and T2D when conducting
personal research.
Conclusions: Multiple factors were perceived to affect sleep in this
sample of patients with T2D. While current advice provisions seem
to only consider controlling diet and physical activity, the results in-
dicate that participants are not aware of the role of sleep in control-
ling T2D. The findings highlight that, in addition to advice on diet and
physical activity, diabetes health care guidelines need to mention
the importance of sleep and include strategies for practising sleep
hygiene.
Disclosure: Nothing to disclose.
P424 | A complex relationship between
obstructive sleep apnea syndrome, inflammation
and oxidative stress
A.D. Maierean; N. Motoc; B. Hancu Domokos; D.A. Todea
Pneumology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj
Napoca, Romania
Objectives/Introduction: Obstructive sleep apnea (OSA) is charac-
terised by chronic intermittent hypoxia, which enhances oxidative
stress and systemic inflammation. In the majority of the cases, OSA
is associated with obesity and a high risk of cardiovascular and meta-
bolic diseases.
|
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We assessed the impact of respiratory parameters on inflammatory
and oxidative stress profile in patients with moderate/severe OSA.
Methods: The study population included 42 consecutive patients di-
agnosed with moderate/severe OSA. We assessed body mass index
(BMI), complete blood count, inflammatory parameters (C-­reactive
protein/CRP, neutrophile/lymphocyte ratio NLR) and markers of
oxidative stress as exhaled carbon monoxide level (eCO) and blood
carbon monoxide (COHb) in the morning following the nocturnal
cardiorespiratory poligraphy.
Results: In our study group, the majority of the patients were male
(66.7%), with a mean age of 58.04 years, which associate obesity
with a mean BMI of 41.12 ± 8.33 kg/m2. Taking into account the
smoking habit, 33.3% were active smokers, 21.4% ex-­smokers and
45.2% non-­smokers (NS). The mean apnea-­hypopnea index (AHI)
was 69.56 ± 40.41 events/hour of sleep, the mean oxygen desat-
uration index (ODI) was 70.89 ± 41.35 events/hour of sleep, with
a mean nocturnal SpO2 of 82.9 ± 11.42% and a minimum SpO2 of
67.76 ± 13.11%. There were statistically significant correlation be-
tween oxidative stress parameters (eCO) and CRP (p = 0.008), NLR
(p = 0.001), AHI and ODI (p < 0.001) and also mean and minimum
SpO2 (p < 0.001). Patients with severe OSA have higher values of eCO
(4.31 ± 2.83) compared to those with moderate OSA (2/p = 0.003).
In addition, we found significant correlation between inflammatory
profile and nocturnal cardiorespiratory poligraphy parameters, AHI
and ODI (p < 0.001), mean nocturnal SpO2 (p = 0.015) and minimum
nocturnal SpO2 (p  =  0.013). Considering the smoking habit, in pa-
tients with severe OSA, the eCO value was 5.8 ± 2.52 ppm in the
smokers group versus 1.83 ± 0.93 ppm in NS (p  <  0.001) and the
COHb was 3.08 ± 1% in the smokers group versus 2.12 ± 1.03% in
the NS (p = 0.011).
Conclusions: In patients with moderate/severe OSA, we found a sig-
nificant correlation between respiratory parameters and inflamma-
tory/oxidative stress profile, with an impact on cardiovascular and
metabolic disorders.
Disclosure: Nothing to disclose.
P425 | Maxillo-­mandibular advancement
surgery role in obstructive sleep apnea syndrome
treatment: case series
S.I. Guerra; Â. Cunha; J. Vale; A. Reis; C. Santos; C. Sousa; R.
Oliveira; A. Simões Torres
Pulmonology, Centro Hospitalar Tondela-­Viseu, Viseu, Portugal
Objectives/Introduction: Maxillo-­mandibular advancement (MMA)
surgery is an alternative treatment in obstructive sleep apnea syn-
drome (OSAS), particularly in those with positive airway pressure
(PAP) intolerance and craniofacial deformities. It expands the infe-
rior facial skeleton anteriorly, enlarging the hypopharyngeal space
and reducing its collapsibility. The aim of this study is to describe the
MMA surgery impact in OSAS treatment.
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276 of 356       ABSTRACTS
Methods: Retrospective study of OSAS patients who underwent
MMA surgery between 2014–2018. Patients with preoperative and
postoperative polysomnographic study were included.
Results: 5 cases were identified, all male, with median age of
34 years-­old and mean body mass index 30.7 ± 5.6 kg/m2. All pa-
tients were proposed PAP as initial treatment, however 2 were
noncompliant and one refused it. All had dentofacial deformities,
as retrognathia or micrognathia, therefore submitted to maxillo-
facial surgery. Median preoperative apnea-­hypopnea index (AHI)
was 35.60 ± 87.80 events/ hour (minimum 18.7; maximum 171.1)
and postoperative AHI 6.6 ± 11.2 events/hour (minimum 5.0; maxi-
mum 25.2). Surgical success, defined as > 50% AHI reduction, was
achieved in 4 cases. Surgical cure, defined as postoperative AHI < 5,
was not observed. One patient improved to moderate OSAS and
maintained treatment with PAP, but with lower pressure and better
compliance. All patients improved daytime sleepiness and snoring.
No major complications were observed.
Conclusions: All patients achieved clinical improvement. There was
surgical success, without further treatment needed, in 4 of 5 pa-
tients. MMA surgery seems to be a good alternative treatment in
moderate to severe OSAS in case of PAP intolerance and craniofacial
deformities. Early referral and patient selection for this surgery is
very important.
Disclosure: Nothing to disclose.
P426 | Depression and sleep quality of
obstetricians in South Korea
K.T. Kim1; Y.W. Cho1; S. You1; H.Y. Seok1; H. Park1; W.-K.
Jang2; J.G. Bae2
1 age groups (ages 40–64 years vs. 65–79 years), and between the
Neurology; 2Obstetrics and Gynecology, Keimyung University School
of Medicine, Daegu, Republic of Korea
Objectives/Introduction: Obstetricians play a pivotal role in preg-
nancy. Also, they frequently encounter common comorbidity, such
as pregnancy-­related depression. We investigated the working con-
ditions, depression, and sleep status of obstetricians in South Korea.
Methods: This is a questionnaire-­based cross-­sectional survey, per-
formed from December 2019 to January 2020. Board-­certificated
obstetricians were asked to complete a series of questionnaires, in-
cluding demographic information, the Beck's depression inventory-­2
(K-­BDI), Pittsburgh sleep quality index (K-­PSQI), insomnia severity
index, Epworth sleepiness scale, and STOP.
Results: A total of 107 obstetricians completed the questionnaires.
Their mean age was 50.60 ± 7.83, and 83 (77.6%) were male. The
average years after the board certification were 17.80 ± 7.62.
They work 68.90 ± 19.61 hours a week, and sleep for 7 hours
(06:59:20.75 ± 01:08:21.63), approximately. The number of duty days
and deliveries in the last month were 6.44 ± 4.35 and 28.95 ± 25.16
per month, respectively. Forty-­five (42.1%) obstetricians had poor
sleep quality, 22 (20.6%) had suspicious insomnia, and 45 (42.1%)
had significant depression. In multiple regression analyses, K-­PSQI
(standardized β = 0.492, p < 0.001) and the number of deliveries in
the last month (standardized β = 0.453, p < 0.001) showed significant
influence upon K-­BDI.
Conclusions: The risk of depression increased by 8.8% as another
monthly delivery was performed. A point in K-­PSQI increased the
risk of depression by 49.6%. The worse the sleep quality, and the
more frequent deliveries, the more depressed the obstetrician is.
Disclosure: Nothing to disclose.
P427 | Women are more susceptible to aging in
chronic insomnia disorder
J.K. Hong; I.-Y. Yoon
Neuropsychiatry, Seoul National University Bundang Hospital,
Seongnam-­si, Republic of Korea
Objectives/Introduction: Despite numerous evidence showing dif-
ference in physiologic sleep according to age and sex, there were
limited studies investigating age effect and sex difference in mani-
festation of insomnia beyond prevalence. This study aimed to inves-
tigate difference in subjective and objective sleep parameters and
resting-­state quantitative electroencephalogram (qEEG) of insomnia
disorder according to gender and age.
Methods: Patients with insomnia disorder aged between 40 and
79 years were recruited. We assessed each participant with sleep
questionnaires including Pittsburgh Sleep Quality Index (PSQI), 4-­
day wrist actigraphy, and qEEG derived from a 64-­channel electro-
encephalogram system. We compared the parameters between the
male and the female subjects.
Results: Among 173 participants, 61 (35%) were elderly, and 64 (35%)
were male. The elderly group reported poorer PSQI sleep than the
middle-­aged group with higher total scores (p = 0.022) and shorter
total sleep time (PSQI TST, p = 0.008). Between genders, men slept
for significantly shorter time according to actigraphy than women
(p = 0.040), while women had higher relative beta power compared
to men (frontal, p = 0.014; temporal, p = 0.049; central, p = 0.001;
parietal, p = 0.012; occipital, p = 0.047). Moreover, the age effect was
noticeable in women, but not in men. The elderly women showed
particularly decreased PSQI TST (p = 0.025) with lower ratio of TST
(PSQI TST/actigraphic TST, p  =  0.034) compared to the middle-­
aged women. The older women also had significantly reduced alpha
(p = 0.009) in frontal area with slowed dominant occipital frequency
(DOF, p = 0.013) compared to the younger women.
Conclusions: Among adult patients with insomnia, not only the clini-
cal sleep parameter but electroencephalogram and the age effect
on it were different between men and women. Women with insom-
nia may become more susceptible to sleep disturbance with aging,
which is associated with more brain activity changes. This fragility
ABSTRACTS
may further impact the behavior of elderly women with insomnia
such as staying in bed for longer time or seek for sleep aids.
Disclosure: Nothing to disclose.
P428 | Study of relationship among fatigue,
sleepiness and depression based on sleep EEG
1 2 3 3 1
Y. Goto ; K. Fujiwara ; Y. Sumi ; M. Matsuo ; M. Kano ; H.
Kadotani3
1
Kyoto University, Kyoto; 2Nagoya University, Nagoya; 3Shiga
University of Medical Science, Otsu, Japan
Objectives/Introduction: Fatigue, sleepiness and depression are as-
sociated with sleep condition and many studies indicated that they
have unique sleep characteristics although it has been difficult to
clearly distinguish them based on objective indicators. In this work,
we aimed to clarify the difference of sleep EEG according to the
severities of fatigue, sleepiness and depression measured by using
questionnaires.
Methods: We performed a sleep test and a questionnaire survey.
The all of participants were staffs working at the Koka city hall, Shiga
prefecture, Japan, and the number of participants was 652 (male
288; 45.8 ± 12.2 y.o., female 384; 44.6 ± 11.2 y.o.). They were asked
to answer the Chalder Fatigue Scale (CFS), the Epworth Sleepiness
Scale (ESS), and Patient Health Questionnaire-­9 (PHQ-­9). In addi-
tion, their EEG in one night was measured at home with Sleep Scope
(Sleep well Inc.). Based on the measured EEG data, we derived the
total of 45 sleep indexes such as the total sleep time (TST), the sleep
circles, the number of nocturnal awakenings.
We defined CFS  ≥  16 as fatigue, ESS  ≥  8 as sleepy, and PHQ  ≥  4
as depression. We compared the sleep indexes between a fatigue
and non-­sleepy group (N = 120) and a non-­fatigue and sleepy group
(N = 106). In addition, a fatigue and non-­depression group (N = 75)
and non-­fatigue and depression group (N = 64) were compared. The
t-­test was used (p = 0.05).
Results: In the fatigue and non-­sleepy group, the first sleep circle
was significantly shorter, and the second sleep circle was signifi-
cantly longer in comparison with the non-­fatigue and sleepy group.
The ratio of the first sleep circle to TST of the fatigue and non-­
depression group was significantly smaller than the non-­fatigue and
depression group. Thus, shortening of the first sleep circle in the fa-
tigue group was observed. Previous studies reported that the REM
sleep latency and the first sleep circle become short in depression.
Our result indicated that this changes in sleep may be caused by fa-
tigue associated with depression.
Conclusions: Our result showed that the first sleep circle becomes
short due to fatigue. We will investigate the relationship between
depression and sleep as well as fatigue.
Disclosure: Nothing to disclose.
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P429 | Circadian rhythm of heart rate checked
by wearable devices tends to correlate with the
circadian rhythm of salivary cortisol in healthy
adults
S. Jeong1; Y. Lee1; J. Seo1; S. Jeon1; C.-H. Cho2; J. Lee1; T.
Lee1,3; H.-J. Lee1
1
Korea University College of Medicine, Seoul; 2Chungnam National
University Hospital, Daejeon; 3Sungshin Women's University, Seoul,
Republic of Korea
Objectives/Introduction: The common method of measuring human
circadian rhythm was to measure core body temperature or dim-­light
melatonin onset(DLMO). However, these two methods were diffi-
cult to easily apply in daily life. In this study, we determined whether
24 hour changes in heart rate and step count using wearable device
were related to 24 hour changes in the salivary cortisol level, and
looked at the possibility that wearable devices could be used as an
indicator of circadian rhythm misalignment.
Methods: For 13 healthy adults, the heart rate and step count were
continuously measured by wearing Fitbit Charge2 for 5 days, and the
saliva were sampled every 4 hours, excluding sleep time, for 48 hours
to measure the salivary cortisol level. Cortisol levels were checked
by enzyme-­linked immunosorbent assay (ELISA). The cosinor analyses
from the serial salivary cortisol level, heart rate and step count re-
ported the acrophase, period, mesor, and R square of three parameter.
Results: Pearson correlation between acrophase of salivary cortisol
and of the heart rate (r = 0.55, p = 0.064) was found to be stronger
(r  =  0.55, p  =  0.064) than of salivary cortisol and of step count
(r = −0.2, p = 0.533) in 13 healthy adults.
Conclusions: The acrophase of the circadian rhythm of the heart rate
checked by wearable devices tended to correlate with that of salivary
cortisol levels, but the acrophase of the step count did not. The re-
sults suggested that the heart rate measured using the wearable ac-
tivity tracker was a relatively reliable biomarker than the step count.
Disclosure: Nothing to disclose.
P430 | Moderating effects of sleep problems in
the relationship between depression and suicide
attempts
D. Kim; S. Choi; Y. Lee
Psychology, Duksung Women's University, Seoul, Republic of Korea
Objectives/Introduction: This study aims to investigate the effects
of sleep problems on the relationship between depression and sui-
cide attempts.
Depression is the best predictor of suicide. In addition, sleep prob-
lems are associated with a high risk of suicide. Previous studies have
shown that sleep problems affect suicide even after controlling
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278 of 356       ABSTRACTS
depression. Also, considering that depression and sleep problems
can exist independently, it is essential to prevent suicide by identify-
ing the effects of sleep in the relationship between depression and
suicide attempts.
Methods: Subjects: Data were collected from 145 students from uni-
versity in Seoul, Korea who agreed to participate in the study.
Measurement: Depression: The score for the Center for Epidemiologic
Studies Depression scale (CES-­D) excluding item 11
Sleep problem: Item 11 of CES-­D ‘My sleep was restless’.
Suicide attempt: Item 5 of Suicidal Ideation Scale ‘I have made
attempts to kill myself’.
Analysis: The suicide attempt was log-­transformed for the nor-
mality of the variable. Then the interaction effect was analyzed with
SPSS Process Macro and Johnson-­Neyman (J-­N) was analyzed.
Results: In the relationship between depression and suicide attempt,
the interaction effect of sleep problems was statistically significant
(b = 0.0027, t (141) = 3.2882, p = 0.0013). And this interaction was
found to explain the dispersion of suicide attempt by 5.96% signifi-
cantly (ΔR 2 = 0.0596, p = 0013). As a result of J-­N analysis, the inter-
val with significant conditional effect was over 0.5909. That is, when
the sleep problem was 0, the relationship between depression and
suicide attempt was not significant, and if it was 1 or more, the re-
lationship between depression and suicide attempt was significant.
Conclusions: Therefore, the effect of depression on suicide at-
tempts can be considered to depend on sleep problems. That is, as
depression increases, suicide attempts increase, and as sleep prob-
lems increase, this tendency increases. Also, in the absence of sleep
problems, the relationship between depression and suicide was no
longer significant. This suggests that it is necessary to understand
sleep problems in order to prevent suicide of depressed people.
Disclosure: Nothing to disclose.
P431 | Changes in sleep patterns in relation
to hand eczema and atopy symptoms during the
first year of hairdressing apprentices’ education
A. Koscec Bjelajac1; Z. Franic1; M. Ticic2; P. Beuk1; J. Macan1
1
Institute for Medical Research and Occupational Health; 2Division of
Psychology, Faculty of Croatian Studies, University of Zagreb, Zagreb,
Croatia
Objectives/Introduction: Education for hairdressing profession
takes place in developmental period associated with complex bi-
opsychosocial changes including those in sleep. It also involves high
risk for developing occupational skin diseases due to the exposure to
skin irritants and sensitizers. Skin conditions may adversely impact
well-­being of adolescents, but little is still known about the relation-
ship between these conditions and sleep-­wake rhythm. To examine
the interplay of these factors we explored the changes in sleep pat-
terns with respect to hand eczema and atopy symptoms in hairdress-
ing apprentices during the first year of their education.
Methods: This prospective cohort study involved 302 participants
(96% girls, M = 15.2 years) and collected data at baseline and the first
follow-­up six months later. Sleep patterns in three social situations
-­school weeks with morning schedule (MS), afternoon schedule (AS)
and weekend (W) -­were assessed by Croatian adaptation of School
Sleep Habits Survey. Hand eczema and skin and/or respiratory
atopy symptoms were assessed by means of Nordic Occupational
Skin Questionnaire, International Study on Asthma and Allergy in
Children Questionnaire, and clinical interview and examination.
Results: Mixed ANOVAs showed progressively later bedtimes and
wake-­up times, and longer sleep duration across three social situations
(W > AS > MS, all p < 0.001). In addition, apprentices significantly de-
layed their bedtimes (all p < 0.001) and shortened their sleep duration
(all p < 0.01) at six-­month follow-­up when compared to baseline. They
also reported more hand eczema symptoms at follow-­up than at base-
line (p < 0.001). The apprentices who reported hand eczema symptoms
at baseline and follow-­up went to bed later than those who did not re-
port these symptoms (p < 0.01 and p < 0.05, respectively). Furthermore,
the apprentices who reported skin and/or respiratory atopy symptoms
in clinical interview at follow-­up went to bed later (p < 0.05) and woke
up later (p < 0.01) than the group without atopy symptoms.
Conclusions: Allergic and contact skin conditions seem to be re-
lated to changes in sleep-­wake patterns in adolescent hairdressing
apprentices. This study points to its impact especially on bedtime.
Further studies are needed to examine the impact on their well-­
being and daytime functioning.
Disclosure: Nothing to disclose.
P432 | Lipid profile in peri-­and
postmenopausal women with sleep disorders
N. Semenova; I. Madaeva; S. Kolesnikov; L. Kolesnikova
Scientific Centre of Family Health and Human Reproduction Problems,
Irkutsk, Russian Federation
Objectives/Introduction: In recent years, it has been suggested that
sleep has a regulating role in lipid homeostasis. Moreover, it has been
shown that the lipids concentration might depends on the circadian
system. The aim of this study is an assessment of lipid profile param-
eters in peri-­and postmenopausal women.
Methods: 126 menopausal women divided into perimenopausal
(n = 56) and postmenopausal (n = 70) groups were examined. Each
group was divided into control (without sleep disorders) and main
groups (insomnia and insomnia with obstructive sleep apnea syn-
drome (OSAS). Pittsburg Sleep Quality Index, Epworth Sleepiness
Scale, Insomnia Severity Index, polysomnography were used for the
assessment of sleep disorders. Lipid metabolism parameters by the
enzymatic method were determined.
Results: The increase of total cholesterol and low-­density lipoprotein
cholesterol levels were observed in perimenopausal women with in-
somnia and OSAS. The increase of total cholesterol, triacylglycerol,
ABSTRACTS
low-­
density lipoprotein cholesterol, very-­
low-­
density lipoprotein
cholesterol levels and decrease of high-­density lipoprotein choles-
terol level were found in postmenopausal women with insomnia and
OSAS as compared to control and group with insomnia. There were
no differences in lipid metabolism parameters in groups only with
insomnia as compared to control.
Conclusions: Our data proved that only insomnia comorbidity with
OSAS are associated with lipid metabolism changes both in peri-­and
postmenopausal women.
Disclosure: The authors report no conflicts of interest.
P433 | Validation of the Armenian version of
the Epworth sleepiness scale
M. Isayan; H. Hovakimyan; S. Khachatryan
Somnus Neurology Clinic, Yerevan, Armenia
Objectives/Introduction: Excessive daytime sleepiness (EDS) is char-
acterized by difficulties maintaining wakefulness and alertness during
the daytime. EDS is a recognized risk factor for car/work accidents
and is associated with a diagnosis of hypersomnolence disorders of
central origin and secondary EDS to other disorders, e.g. obstructive
sleep apnea (OSA). Correct diagnosis may help to prevent EDS-­related
complications and lead to a better quality of life. Quantification
of EDS is an essential approach in modern sleep medicine. Several
sleepiness assessment scales are available, with the Epworth sleepi-
ness scale (ESS) being the most widely studied and used. We aimed to
translate and validate the Armenian version of ESS (ESS-­Arm).
Methods: The ESS is an 8-­item originally English self-­administered
questionnaire for EDS evaluation with other translated and vali-
dated language versions available. Forward-­and back-­translation of
the ESS was performed by two independent lines of translators. For
test-­retest stage, it was administered to healthy volunteers and ter-
tiary sleep center patients during the first visit. Internal consistency
was analyzed by Cronbach's alpha. Participants were retested within
the following 4–14 days. Pearson's correlation analysis was used to
analyze test-­retest reliability. The validation group included patients
with different sleep disorders mostly with OSA suspicion tested by
the ESS-­Arm before undergoing polysomnography (PSG).
Results: We enrolled 88 subjects in the test-­retest group with mean
age 37.8 years (18–74), (F-­48.9%). The ESS-­Arm's Cronbach's alpha
was 0.86. For test-­retest reliability, the correlation analysis showed
the following range for each component (C1–C8) of the ESS (p < 0.01):
C1-­0.84, C2-­0.82, C3-­0.74, C4-­0.8, C5-­0.72, C6-­0.81, C7-­0.70, C8-­
0.81. For validation group (n = 52, mean age = 49 years (22–81), F-­
39.6%) we used objective data from PSG studies correlating with
the mean total ESS score. Spearman's analysis showed strong and
significant positive correlations for apnea-­hypopnea index (r = 0.58),
respiratory disturbance index (r = 0.62), oxygen desaturation index
(r = 0.57), and arousal index (r = 0.64) (p < 0.05).
|
      279 of 356
Conclusions: Our study results confirm the ESS-­Arm as a valid tool
with high internal consistency and reliability. The ESS-­Arm scores
were mostly correlated with polysomnographic OSA-­related vari-
ables. The ESS-­Arm can be reliably used in clinical practice for the
EDS assessment of the Armenian-­speaking population.
Disclosure: Nothing to disclose.
P434 | Closed-­loop acoustic neurostimulation
during Sleep: targeting theta waves
J. Patriota1; E. Juan1; I. Korjoukov2; L. Talamini1; U. Olcese1
1
Universiteit van Amsterdam, Amsterdam, The Netherlands; 2Okazo
Lab, London, UK
Objectives/Introduction: Recently there has been an increasing in-
terest in the potential applications of closed loop neuro-­stimulation.
Most studies are focused on targeting slow waves during NREM sleep,
to improve memory consolidation. REM sleep plays a crucial role in
emotional processing, which is essential for mental health. Theta is
a hallmark of REM sleep, therefore detecting and manipulating theta
waves could pave the way towards targeted interventions in clinical
and sub-­clinical populations. We present the first results on the de-
velopment of an algorithm able to detect and target precise phases of
theta (4–8 Hz), which could be used to further address how targeting
can play a role on memory reactivation and memory consolidation.
Methods: Data of nine participants (9 females; aged 20 ± 1.7 years)
underwent a night of polysomnography and EEG recordings in the
lab. Ten minutes of recorded REM epochs from each subject were
separately used to run the closed-­loop acoustic neurostimulation
(CLNS) system, targeting the 0-­degree phase of theta.
Targeting procedure involves an oscillatory phase prediction algo-
rithm, based on non-­linear sine fitting on the most recent data seg-
ment of unfiltered EEG signal. The criteria for stimulus release are: 1)
The fitted sine is in a frequency range of interest, 2) The fitting error
is below a given threshold and 3) The prediction is within a delimited
future time window. The algorithm is implemented within EventIDE
software (Okazolab). Predictions were made on the real-­time data of
the channel (Fz-­XM), in the theta range. This method has been previ-
ously applied to the slow oscillation frequency range, in both offline
simulations and online recordings.
A Rayleigh test of circular uniformity was employed.
Results: In this study targeted the 0 phase of theta oscillations.
Across all participants we achieved a mean target phase of -­7 de-
grees, standard deviation of 37.51 degrees and made, on average,
163.78 predictions for each separate REM epoch.
Conclusions: These results on offline simulation of previously re-
corded data suggest that it is possible to reliably target specific
phases of theta oscillations in a closed loop setup. This brings possi-
bilities of a different tool for non-­invasive intervention on processes
that happen during sleep.
Disclosure: Nothing to disclose.
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280 of 356       ABSTRACTS
P436 | Development of autonomic nervous
system evaluation method by using heart rate
variability analysis and multivariate statistical
process control
C. Nakayama1; K. Fujiwara2; Y. Sumi3; M. Matsuo3; M. Kano1;
H. Kadotani4
1
System Science, Kyoto University, Kyoto; 2Engineering, Nagoya
University, Nagoya; 3Psychiatry; 4Department of Sleep and Behavioral
Sciences, Shiga University of Medical Science, Shiga, Japan
Objectives/Introduction: Since Dementia with Lewy body (DLB)
causes autonomic dysfunction like orthostatic hypotension, au-
tonomic nervous system (ANS) evaluation methods are required.
One of the methods is Schellong-­test. However, ANS reflects his/
her condition. We propose a new ANS method which can be used in
daily life based on heart rate.
Methods: Schellong-­tests have been conducted for 60 healthy peo-
ple and 30 patients with REM sleep behavior disorder, which is a risk
factor of DLB. The heart rate variability (HRV) reflects the ANS, and
Poincare plot has been used for HRV analysis. Three-­dimensional
Poincare plot features and time-­domain HRV features were used
in our proposed method. For HRV analysis, a rectangular window
function was used and its window size was three minutes. While
the healthy HRV features (12426 samples) were calculated from
29 healthy people, whose Schellong test results were negative, the
positive HRV features (2261 samples) were calculated from 5 posi-
tive patients in Schellong-­test. The proposed method uses the HRV
features as input variables of multivariate statistical process control
(MSPC), which is used in process monitoring. MSPC defines the nor-
mal operating condition with two monitored indexes, i.e., the T2 and
Q statistics. In order to determine whether the subject is a Schellong
positive patient or not, the Q statistics ratio(Qr) is used: Qr  =  100
q/n[%], where q is the sum of the Q statistic exceeding the control
limit, and n is the total number of input samples.
Results: The validation data consist of the HRV features extracted
from 30 healthy people (13484 samples) and 6 positive patients
(2979 samples) that were not used for modeling. When the thresh-
old of the Qr was set to the average of the Qr of the healthy people
and the positive patients in the modeling data, the sensitivity and the
specificity of the validation data were 83% and 83%, respectively.
Conclusions: In the present work, we developed a new ANS eval-
uation method based on HRV analysis and MSPC. By using this
method, Schellong-­test results can be estimated in daily life because
heart rate can be measured with wearable sensors.
Disclosure: Nothing to disclose.
P437 | The effect of wind farm noise on
subjective and polysomnographically measured
sleep onset latency: a pilot study
T. Liebich1; G. Micic2; K. Hansen3; B. Zajamsek 2; N. Lovato2;
P. Catcheside2; C. Dunbar1; B. Lechat3; F. Decup3; L. Lack 2
1
College of Education, Psychology and Social Work; 2College of
Medicine and Public Health; 3College of Science and Engineering,
Flinders University, Adelaide, SA, Australia
Objectives/Introduction: Noise has the potential to disturb sleep,
but little is known regarding the specific effects of wind farm noise
on objective and psychometrically validated measures of sleep. To
help inform the protocol of a larger study, this pilot study assessed
the impact of wind farm noise on objective and subjective sleep
onset latency using the gold standard measure for sleep (i.e., poly-
somnography) and the psychometrically validated Consensus Sleep
Diary.
Methods: Twenty-­
three individuals (Mean ± Standard Deviation
21.7 ± 2.1 years, age range: 18–29, 13 females) without previous ex-
posure to wind farm noise attended the sleep laboratory for two
overnight sleep studies, scheduled one week apart. Participants
were exposed to the presence of amplitude modulated wind farm
noise on one night and a counterbalanced quiet background noise
control night. The wind farm noise level and amplitude modulation
depth were at the upper end of expected indoor values. Objective
and subjective sleep onset latencies were determined from poly-
somnography and the Consensus Sleep Diary, respectively.
Results: Linear mixed model analyses revealed no differences in ob-
jective sleep onset latency between the experimental (median [in-
terquartile range]: 16.8 [10.9 to 18.5] min) and control night (15.5
[9.6 to 28.6] min), p  =  0.49 and no differences in subjective sleep
onset latency between the experimental (17.5 [13.8 to 21.3] min)
and control night (15.0 [10.0 to 30.0] min), p = 0.70. Furthermore, on
average, participants had a 1.2-­minute reduction in objective sleep
onset latency (95% CI = 5.71) and a 0.4-­minute reduction in subjec-
tive sleep onset latency (95% CI = 4.17) in the presence of WFN in
comparison to control background noise.
Conclusions: These results do not support that amplitude modulated
wind farm noise delays sleep onset latency in wind farm noise naïve
individuals. Further carefully controlled laboratory studies are war-
ranted to comprehensively evaluate prior wind farm noise exposure
and sleep parameters beyond sleep onset latency, which were meth-
odological limitations in the present study.
Disclosure: Nothing to disclose.
ABSTRACTS
P438 | Reasons for sleeping difficulties as
perceived by adolescents
M. Jakobsson1; K. Josefsson1,2; K. Högberg1
1 1
Department of Caring Science, University of Borås, Borås;
2
Department of Nursing, Karlstad University, Karlstad, Sweden
Objectives/Introduction: Sleeping difficulties are increasingly
prevalent among adolescents worldwide and have negative conse-
quences for health, well-­being, and education. In order to develop
and implement health promotion about sleep, additional knowl-
edge is required, especially knowledge based on adolescent´s own
experiences. This kind of research is currently limited. This study
aimed to describe reasons for sleeping difficulties as perceived by
adolescents.
Methods: This was a descriptive study, analyzing the data with quali-
tative and quantitative content analysis. Data was collected using an
open ended question in a questionnaire; If you experience that you
sleep too short, have trouble falling asleep, wake up at night or sleep
not rested, please write what you think your sleeping difficulties may be
due to. The participants consisted of 475 adolescents in grade nine
(15–16 year), in 13 secondary schools, in a Swedish city.
Results: The adolescent´s descriptions of reasons for sleeping dif-
ficulties are understood as an imbalance between requirements and
preconditions. Requirements are about performing at school, doing
activities, being social both digitally and in real life, having fun, tak-
ing care of their health, reflecting on the existence and the future.
Preconditions can be about having time, structure and parental sup-
port, but also an ability to set your own limits. When the precondi-
tions are insufficient to match the requirements, an imbalance occurs
where sleep loses out. Six different categories described reasons for
adolescents sleeping difficulties. The most prominent reason was
stress followed by technology use and then poor sleep habits, exis-
tential thoughts, needs, and suffering.
Conclusions: In order to avoid sleeping difficulties, adolescents need
to deal with reasons such as stress, technology use, non-­existent
sleeping habits, existential considerations, needs and various forms
of suffering. Adolescents need support to find a functioning balance
in everyday life, dealing with these reasons. The support is needed
from especially parents but also from professional caregivers. All
health professionals caring for adolescents should remain vigilant re-
garding the important issue of sleeping difficulties, as good sleep hy-
giene optimizes adolescents’ capability for health and development.
Disclosure: Nothing to disclose.
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P439 | The quality of sleep in high school urban
students
M. Dumitraș1; A. Lupusor1,2; V. Vovc1,2
State University of Medicine and Pharmacy of the Republic of
Moldova, Chișinău; 2Laboratory of Functional Neurology | Sleep
Medicine Center, Institute of Neurology and Neurosurgery, Chisinau,
Republic of Moldova
Objectives/Introduction: High school students in their adolescence
age need at least 8–9 hours of good quality sleep. Their sleeping prob-
lems are thought to be due to late melatonin secretion and bad sleep
habits, especially in the urban population. The aim of this study was to
assess the sleep habits and sleep quality of high school urban students.
Methods: An anonymous online questioning of high school students
(grades 10–12), from 7 lyceums of Chisinau and Balti, included:
questions regarding sleep habits, the Pittsburgh Sleep Quality Index
(PSQI) and the Epworth Sleepiness Scale (ESS).
Results: The mean age of 118 responders was 17 ± 1.1 years, male to
female ratio 1:2.6. The mean time of actual sleep was 6.5 ± 0.9 hours,
41.5% (49/118) slept less than 7 hours per day, and 98.3% (116/118)
went to bed after 10.00 PM. 96.6% of participants (114/118) declared
the usage of the cell phone before bedtime, 66.9% (79/118) -­the con-
sumption of coffee and energizers after 5:00 PM and 45.8% (54/118)
declared eating carbohydrates after 7:00 PM. The prevalence of
smokers was 10.2% (12/118). The mean ESS was 6.9 ± 0.6, but in
84.7% (100/118) of participants was registered higher normal day-
time sleepiness (6–10 points). The mean PSQI score was 7.2 ± 0.5, and
the prevalence of ‘poor’ sleepers (PSQI score > 5) was 69.5% (82/118).
Conclusions: More than a third of high school students slept less than
7 hours per day, and every second had poor sleep habits. About half
of the responders waked up tired, and the majority of the students
are drowsy during the day. Also, the sleep quality was assessed as
bad and very bad. This condition can negatively influence cognitive
performances, behaviour and life quality in high school students. An
awareness program about the importance of healthy sleep and circa-
dian rhythm should be organized for the high-­school students.
Disclosure: Nothing to disclose.
P440 | Sleep deprivation vs electronic devices
in school children
A. Lupusor1,2; D. Olteanu-Pascal1; N. Lupusor1; V. Vovc1
1
State University of Medicine and Pharmacy of the Republic of
Moldova, Chișinău; 2Laboratory of Functional Neurology, Sleep
Medicine Center, Institute of Neurology and Neurosurgery, Chisinau,
Republic of Moldova
Objectives/Introduction: Schoolchildren are using multiple forms
of technology late into the night without prudence or restrictions.
 |
282 of 356       ABSTRACTS
Subsequently, their ability to stay alert and fully functional through-
out the day is impaired. The aim of this study was to asses sleep
disturbances and sleep hygiene in school children.
Methods: Our study included a group of 80 school children (29
boys) aged 8 to 12 years (mean 9.4 StDev ± 1.2 years). The children's
parents were online questioned by the Sleep Disturbance Scale for
Children questionnaire (SDSC), questions regarding sleep habits.
Results: According to the SDSC, the mean T score was 43.3. Twenty-­
three % of children obtained a normal and 77 % presented an abnor-
mal score. The main affected scales were: ‘Disorders of initiating and
maintaining sleep’ ‘Disorders of excessive somnolence’ and ‘Sleep
hyperhidrosis’. The mean time of actual sleep was 9 ± 0.9 hours, 45%
(36/80) slept 9–11 hours, 43 % slept 8–9 hours, and 12 slept less
than 8 hours per day. Difficulties of falling sleeping had 44%, 57%
of children had anxiety and fear when falling asleep. Forty-­nine % of
children presented hyperhidrosis, 33 % felt tired in the morning, and
15% were sleepy during the day. In the same time, 38% were using
the gadgets more the 2 hours after 9:00 PM, and 36 % were falling
asleep with them.
Conclusions: The majority of the children present some sleep dis-
turbances. The main one is sleep deprivation due to the overuse of
different gadgets in the evening and before the time for sleep. Also,
the usage of devices with a screen before sleep increase children's
anxiety, those increasing sleep delay. Unfortunately, it is a modern
trend that is misunderstood by the parents, by the children and the
whole society. Frequently the sleep deprivation in children is consid-
ered something reasonable, and there are not applied measurements
to improve that.
Disclosure: Nothing to disclose.
P441 | Obstructive sleep apnea risk
assessment among diabetes type 2 population in
primary care
J. Silva; M. Sampaio
USF Balsa, Tavira, Portugal
Objectives/Introduction: Obstructive sleep apnea (OSA) is highly
prevalent in the general population, and occurs at all ages. OSA is
characterized by collapse of upper airways during sleep with inef-
fective respiratory efforts, intermittent hypoxia and sleep disrup-
tion. Multiple cross-­sectional studies have shown a high prevalence
of undiagnosed OSA in patients with type 2 diabetes. Untreated
OSA in diabetic patients is associated with increased prevalence of
neuropathy, peripheral arterial disease, diabetic retinopathy and dia-
betic nephropathy. Screening for OSA in diabetic patients should be
systematically done, since CPAP treatment for at least 4 h/night may
be protective.
This study aimed to evaluate the prevalence of high risk of undiag-
nosed OSA among patients with type 2 diabetes in primary care (PC)
setting who should be referred for diagnostic evaluation.
Methods: An observational, analytical and cross-­sectional study was
carried out on a sample of patients from a primary healthcare centre
which attended to a diabetes type 2 follow-­up medical appointment,
between April and September 2019. Sociodemographic and clinical
data were collected through a structured interview and from medi-
cal records. Risk of undiagnosed OSA was evaluated using the STOP-­
BANG questionnaire.
Results: Ninety-­two patients were the study object. The age was
69.56 ± 12 years, 56.52% were male patients, with a neck circumfer-
ence of 38.46 ± 5.18 cm and BMI of 29.43 ± 5 kg/m2. Prevalence of
high risk of OSA (STOP-­BANG score ≥ 3) was 79.35%.
Conclusions: There is a high prevalence of risk for undiagnosed OSA
in the sample analysed. OSA might be considered a modifiable risk
factor for type 2 diabetes development and adverse outcomes in
these patients. PC has a key role in early detection and facilitating
diagnosis. The STOP-­Bang questionnaire is an interesting triage tool
for the primary healthcare setting, selecting those with probable
OSA for diagnostic evaluation, predicting patients with a more se-
vere disorder and those who need faster treatment.
Disclosure: Nothing to disclose.
P442 | Prevalence of erectile dysfunction
among a sample of obstructive sleep apnoea non
treated patients
J. Mauricio1; V. Melo2; E. Lombardia2; I. Gonçalves2; R.
Neveda2
1
Psychiatry; 2Respiratory Medicine, ULSAM, Viana do Castelo,
Portugal
Objectives/Introduction: Study the prevalence of erectile dysfunc-
tion (ED) in obstructive sleep apnoea syndrome (OSAS) non treated
patients.
In recent years, OSAS has become a common and serious problem,
particularly in overweight and older patients and is associated with
different systemic complications. ED has been described as a com-
mon symptom of OSAS and several studies confirm the increased
prevalence of this problem. However, in clinical practice ED investi-
gation is commonly not addressed.
Methods: Patients with newly diagnosed OSAS before any treat-
ment and without any medical comorbidities (except overweight).
All patients were asked to complete the International Index Erectile
Function 5 item version (IIEF-­5) questionnaire for the evaluation of
ED. The severity of breathing disorder was classified as mild, moder-
ate, and severe based on apnoea-­hypopnea index (AHI) which was
ascertained by overnight polysomnography.
Results: Of the 52 participants in the cohort, mean age was
58.8 years (SD 8.7); mean weight 91.9 kg (SD 11.9); mean body max
index 30.9 (SD 3.62) and AHI 34.4 (SD 19.44). 50% of the sample had
severe OSAS (> 30 IAH). The prevalence of ED was 80.8% (42.3%
mild; 19.2% mild-­moderate; 15.4% moderate and 3.9% severe). No
ABSTRACTS
correlation was found between ED and age (p = 0.19), BMI (p = 0.8)
or OSAS severity (p = 0.5). Positive correlation was found between
BMI and OSAS severity (p < 0.002).
Conclusions: The prevalence of ED in OSAS is high and maybe un-
derdiagnosed because many patients do not spontaneously report.
With increasing evidence showing higher rates of ED in these pa-
tients, there is definitely a role for physicians to enquire about each
condition, independently of age or OSAS severity. Further longitu-
dinal prospective studies are needed in order to obtain more details
about these features.
Disclosure: Nothing to disclose.
P443 | Obese and nonobese patients -­which
differences in polysomnographic measures?
J. Costa1; G. Samouco1; F. Ramalho Fernandes1,2; J.M.
Siva1,2; A. Tavares1,2
1 2
Pulmonology Department; Sleep Disorder Clinic, Unidade Local de
Saúde da Guarda, E.P.E., Guarda, Portugal
Objectives/Introduction: Obstructive Sleep Apnea (OSA) is a sleep-­
related disorder characterized by collapse and obstruction of the
upper airway, triggering repeated episodes of airflow reduction or
interruption during sleep. Obesity is considered an important risk
factor for OSA, as approximately 70% of individuals with OSA are
obese. Although it can also occur in non-­obese patients, they may
exhibit different characteristics from obese patients with OSA.
To compare polysomnographic data differences between obese
and nonobese patients with OSA followed at our hospital's Sleep
Disorders clinic.
Methods: From January to December 2019, 82 patients were di-
agnosed with OSA after performing home respiratory polygraphy.
Their anthropometric and polysomnographic data were collected
and compared.
Results: From 82 patients diagnosed with OSA, 39 (47.6%, mean
2
Body Mass Index 26.8 ± 2.2 kg/m ) were obese while 43 (52.4%,
mean Body Mass Index 33.4 ± 3.5 kg/m2) were nonobese. Neck
circumference (NC) was higher in obese patients (42.4 ± 0.6 cm
vs 38.7 ± 0.5 cm, p  <  0.001). There was no significant difference
in mean age between groups (p = 0.779). Most obese patients had
moderate to severe OSA (71.8%). Mean apnea-­hypopnea index (AHI)
was significantly higher in the obese group (35.9 ± 4.7 vs 22.3 ± 2.8,
p  <  0.05), which also showed more oxygen desaturation events
(34.4 ± 4.7 vs 16.7 ± 1.9, p  <  0.01), lower mean oxygen saturation
(90.5 ± 0.4 vs 93.1 ± 0.2, p < 0.001) and greater time in oxygen satu-
ration below 90% (25.8 ± 3.9% vs 6.9 ± 1.6%, p < 0.001).
Conclusions: The results from our retrospective analysis corrobo-
rate the existing evidence that although OSA may occur in nonobese
individuals, obesity significantly increases OSA severity expressed
by higher AHI and worse oxygenation parameters. This might be the
result of upper airway narrowing and compliance changes caused by
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obesity related subcutaneous and periluminal fat deposits, increas-
ing the likelihood of airway collapse.
Disclosure: Nothing to disclose.
P444 | Thyrohydopexy or hydroid suspension,
our experience
G.J. Pérez Ortega; F. Fernandez Machín
Otorrinolaringology, Hospital Universitario Puerta del Mar, Cádiz, Spain
Objectives/Introduction: Obstructive sleep apnea (OSA) is a sleep
disorder characterized by increased resistance to air flow. The posi-
tion of the hyoid bone is often abnormally low in patients with OSA
and can change position between wakefulness and sleep, contribut-
ing to hypopharyngeal obstruction.
Methods: We retrospectively reviewed 3 patients diagnosed with
OSA and treated surgically by thyrohiodopexy. The process followed
in our unit with people diagnosed with OSA, mainly derived from
the Pulmonology Service, young patients with intolerance to CPAP.
We carried out an evaluation and diagnosis phase: Evaluation of the
airway (rhinoscopy, oral cavity (Friedman tongue position) FTP) and
tonsillar hypertrophy). Fibrolaryngoscopy (Lingual tonsil hypertro-
phy (LTH). We performed DISE in the operating room, observing
an epiglottic fall towards the hypopharynx and when performing
the hyoid advancement maneuver, we saw great improvement, we
evaluated by Classification (VOTE) Velopharynx, oropharyngeal lat-
eral walls, tongue and epiglottis). Surgical treatment, horizontal inci-
sion of the skin between the body of the hyoid bone and the thyroid
notch. The upper and lower subplathysmal flaps were raised to ex-
pose the prelaryngeal muscles, which were separated in the midline.
The plane of the thyroid cartilage and the surface of the hyoid bone
were exposed and the thyrohyoid membrane was clearly defined.
With Vicryl 3.0 the hyoid bone was sutured on either side of the
midline with a sharp needle and then directed to the thyroid lamina
on the same side, drilling it from the lateral to the medial surfaces
Results: We observed a great clinical improvement in the patient,
both in their satisfaction index and in the polysomnography study.
All three patients halved the IAH, and two of the three decreased it
below 20. But none of the three used CPAP again.
Conclusions: Hypopharyngeal surgery has shown rapid progress in
recent years because separate oropharyngeal surgery often could
not fully treat OSA. Hyoid suspension surgery restores tension in
the lateral walls of the pharynx, thus preventing lateral collapse. We
support the idea that hyoid suspension produces functional effects
due to changes in muscle tone and reduced collapse of soft tissues
rather than enlargement of the airways.
Disclosure: Nothing to disclose.
 |
284 of 356       ABSTRACTS
P445 | Expansion pharyngoplasty: our
experience
F.J. Fernandez Machin; J.M. Montesinos Gonzalez; I.
Marquez Estefenn
Hospital Universitario Puerta del Mar, Cadiz, Spain
Objectives/Introduction: The obstructive sleep apnea syndrome (
OSAS) it is one of the most prevalent sleep disorders in the gen-
eral population. It occurs as a consequence of repeated episodes
of airway collapse during sleep; This obstruction occurs at the level
of the soft palate, pharyngeal lateral walls, base of the tongue or
epiglottis. Before deciding on an appropriate surgical technique, the
airway should be evaluated using DISE (drug induced sleep endos-
copy). If the obstruction is lateral, it can be corrected by expansion
pharyngoplasty.
Methods: A review of patients diagnosed with moderate-­
severe
OSAS derived from neumology for present: intolerance or lack of
response to CPAP.
A total of 12 cases were found, we evaluated the degree and type
of airway compromise (DISE) ; objectifying a lateral obstruction.
We did expansion pharyngoplasty in all patients. Septoplasty and
turbinoplasty were performed in three patients. In this technique,
we performed tonsillectomy with an electric scalpel, isolating the
palatopharyngeal muscle, rotating it up and out, fixing it at the level
of the hamulus through tunneling of the soft palate, suturing tonsil
abutments and if the patient requires it, perform uvuloplasty.
Results: A lateral collapse was observed at every patient with a
transverse closure among 75%–100%. The average age of the pa-
tients is 44 years (between 21–55 years). The average of preopera-
tive IAH is 51 (between 22–88). An average BMI of 28. They undergo
expansion pharyngoplasty. All patients were evaluated by neumol-
ogy, at least 6 months later, and DISE was performed, obtaining an
average post-­surgical IAH of 13.5 (excluding one case with a BMI of
36, with an IAH of 81 and a post-­surgical of 40).
Conclusions: Cure criteria (preoperative AHI reduction of more than
50% and AHI of less than 20) have seen in ten of twelve. Two pa-
tients became positional SAHS, having to sleep in lateral decubitus.
The patient with an AHI: 81, BMI.36 and AHH post-­surgical: 40, has
been decreased in a half, but still has severe SAHS. The surgery has
been completed with no issues. Modified expansion pharyngoplasty
achieves good results with patients well-­selected.
Disclosure: Nothing to disclose.
P446 | A multicentric, randomised, single-­blind
phase 2 trial to evaluate the pharmacokinetics
and pharmacokinetics-­pharmacodynamics of
trazodone in children and adolescents with
insomnia and neurodevelopmental disorders
V. Tellone; F. Torelli; I. Pochiero; F. Calisti; A. Del Vecchio; M.
Gorini; M.T. Rosignoli; L. Oggianu; P. Dragone; A. Cattaneo
Angelini Pharma S.p.A., Rome, Italy
Objectives/Introduction: Insomnia is a common sleep disorder in
children with a range of neurological conditions, such as neurode-
velopmental disorders (NDDs). NDDs include attention deficit hy-
peractivity disorder (ADHD), autism spectrum disorder (ASD) and
intellectual disability (ID). Children with NDDs and insomnia not re-
sponding to first-­line treatments (i.e. behavioural interventions), be-
come candidates for a pharmacological treatment. Trazodone (TZD)
is a multimodal antidepressant, a serotonin antagonist and reuptake
inhibitor, with a good safety profile. As it has a clearly ameliorat-
ing effect on sleep architecture and improves quality of sleep in
depressed patients, TZD is an ideal candidate to treat insomnia in
patients with NDDs.
The aim of this study is to characterize TZD pharmacokinetics (PK),
in paediatric patients with NDDs affected by insomnia, also assess-
ing linearity in drug exposure across three different dose levels.
Specifically, the primary objective is to evaluate the main PK pa-
rameters of TZD after single and repeated oral doses. The main sec-
ondary objectives are to define pharmacokinetic-­pharmacodynamic
(PKPD) relationship of TZD (assessed by actigraphy measures), con-
centration-­QT interval correlation, dose rationale and safety/toler-
ability profiles.
Methods: This is a multi-­centre, single-­blind, parallel-­group, rand-
omized phase II clinical trial. PK and PD of three dose levels of TZD
are assessed on a maximum sample of 36 children and adolescents
from 2 to ≤ 17 years with diagnosis of insomnia and NDD. Sleep la-
tency and total sleep time are recorded by actigraphy starting from
three consecutive days prior to first drug intake until the end of
treatment (ten days of once daily TZD). Data are summarised using
descriptive statistics or frequency tables.
Results: To date, 23 patients (20 males, 3 females, age range
3-­17 years) were recruited at 7 sites (Italy-­Spain). All had a diagnosis
of insomnia and NDD (ADHD 10, ASD 8, ID 5) according to DSM-­5
criteria. Five patients failed screening or dropped-­out. Eighteen pa-
tients were randomized to the three arms of treatment. No SAE were
recorded.
Conclusions: 78% of currently recruited patients completed the
study. TZD confirmed its good safety and tolerability profile. The
full results of this study will provide new insights about an effective
pharmacological approach for insomnia in children and adolescents
with NDDs.
Disclosure: This study was sponsored by Angelini Pharma S.p.A.,
Viale Amelia, 70 -­00181 Rome, Italy.
ABSTRACTS
P447 | Non-­pharmacological sleep and
circadian rhythm interventions in bipolar
disorder: a systematic review of randomised
controlled trials
L. Bisdounis1,2; K. Saunders2,3; H. Farley4; C. Lee 4; N.M.
McGowan2,3; C. Espie1; S. Kyle1
1
Nuffield Department of Clinical Neurosciences, University of Oxford/
Sleep & Circadian Neuroscience Institute; 2Department of Psychiatry,
University of Oxford; 3Warneford Hospital, Oxford Health NHS
Foundation Trust; 4Clinical Medical School, Medical Sciences Division,
University of Oxford, Oxford, UK
Objectives/Introduction: Sleep and circadian rhythm disturbances
are prominent features of bipolar disorder (BD), observed in both
inter-­episode and acute illness phases. Insomnia, hypersomnia, de-
creased need for sleep, and delayed chronotype are the most preva-
lent symptoms, with genetic, hormonal and activity-­
based data
corroborating those findings. Sleep and circadian disruptions have
also received interest as potential targets of adjunctive interventions
in BD. This is due to their independent association with psychosocial
functioning, their influence on mood, remission and relapse rates,
and the potential to be targeted with non-­pharmacological interven-
tions thus avoiding the accumulation of medications. The aim of this
paper was to systematically review, and whenever possible meta-­
analyse, non-­pharmacological sleep and circadian rhythm interven-
tions for BD.
Methods: Nineteen studies reporting on 18 randomised controlled
trials met the inclusion/exclusion criteria.
Results: Although the risk of bias assessment produced mixed results
that were domain-­dependent, there was a notable trend of improve-
ment in the last five years. Two trials administered blue-­light block-
ing glasses (BB glasses), six trials administered bright light therapies
(BLT), two trials tested a modified cognitive behavioural therapy for
insomnia (CBT-­I), four trials tested interpersonal social rhythm thera-
pies (IPSRT), one trial employed a total sleep deprivation protocol
(TSD), and three trials administered unique combination treatment
regimes. Conflicting results for sleep and mania were found for BB
glasses between the included studies. Effects on sleep and mood
for IPSRT were predominantly positive, with null results observed
only when IPSRT was compared against a medication active control
group. A large significant anti-­depressant effect was observed for
BLT but effects on sleep and functioning varied between-­studies.
This was consistent with trials administering a combination of TSD
and BLT. Post-­treatment and long-­term improvements in sleep and
mania scores were observed for studies administering CBT-­I but no
effects were seen for depression.
Conclusions: Based on the synthesis and appraisal, future work
should aim to appropriately and adequately evaluate the diagnos-
tic groups as well as the sleep and mood psychopathology out-
comes. A complementary review of the registered clinical trials in
the area indicates that future published literature might focus on
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CBT-­I, euthymic patients and objective characterisation of baseline
and post-­treatment sleep problems.
Disclosure: The authors disclose no conflicts of interest. LB is sup-
ported by the Nuffield Department of Clinical Neurosciences sup-
port fund (HMT00230 HM04.01) and by Medical Research Council
Doctoral Training Partnership grant (MR/N013468/1). KEAS is sup-
ported by the NIHR Oxford Health Biomedical Research Centre.
SDK is supported by the NIHR Oxford Biomedical Research Centre.
P448 | Magical ideations and persecutory ideas
in patients with sleep disorders
R. Göder; S. Bares; C. Vogel; H. Böttcher; H. Drews; J.
Lechinger; S. Weinhold
University Hospital Schleswig-­Holstein, Kiel, Germany
Objectives/Introduction: There is a relationship between sleep and
psychotic-­like experiences (PLE), such as magical ideations or perse-
cutory ideas. Sleep disturbances seem to play an important role in
the occurrence of such symptoms.
Methods: We studied 24 subjects with insomnia disorder
(41 ± 13 years), 47 participants with obstructive sleep apnea
(47 ± 11 years) and 33 healthy controls. Sleep in patients with sleep
disorders was recorded and scored according to standard criteria
of the American Academy of Sleep Medicine. PLE were measured
by the Magical Ideation Scale and by the Peters et al. Delusions
Inventory.
Results: The main results were
(1) significantly higher scores of magical and delusional ideations
in patients with insomnia compared to healthy controls;
(2) a tendency of a higher score of delusional beliefs in sleep apnea
patients in comparison to controls;
(3) a significant negative association between sleep spindles and
magical ideations in individuals with insomnia (r = −0.45; partial
correlation controlled for age); and
(4) a significant negative correlation between delusional beliefs and
REM sleep in a subgroup of insomnia patients without antidepres-
sants (r = −0.48; partial correlation controlled for age).
Conclusions: As there are indications that diminutions of sleep spin-
dles are a biomarker for dysfunctional thalamo-­cortical circuits un-
derlying the neuropathology of psychosis, we conclude that there
might be a sub-­group of insomnia patients with fewer sleep spindles
which is more vulnerable to developing a psychotic disorder in the
future.
Disclosure: Nothing to disclose.
 |
286 of 356       ABSTRACTS
P449 | Sleep quality during covid-­19 pandemic
in a Portuguese cohort of respiratory patients
J. Pinto1; M. van Zeller1,2; P. Amorim1,2; A. Pimentel1,2; P.
Dantas1; E. Eusébio1; J. Pipa1; A. Neves1; E. Santa Clara1; T.
Santiago1; P. Viana1; M. Drummond1,2
1
Pulmonology Department, Centro Hospitalar Universitário de São
João; 2Faculty of Medicine of Porto University, Porto, Portugal
Objectives/Introduction: Due to the covid-­19 outbreak, social dis-
tancing measures were imposed to control the spread of the pan-
demic. However, isolation may affect negatively the psychological
well-­being and impair sleep quality. Our aim was to evaluate the
sleep quality of respiratory patients during the covid-­19 pandemic
lockdown.
Methods: All patients who underwent a telemedicine appointment
in the Pulmonology Department from March 30 to April 30 of 2020
were asked to participate in the survey. Sleep difficulties were as-
sessed using Jenkins Sleep Scale (4-­item questionnaire). Additional
clinico-­
demographic data was collected. Multiple logistic regres-
sion modelling was used to identify potential risk factors for sleep
disturbances.
Results: The study population consisted of 365 patients (mean age
63.9 years, 55.6% male, 50.1% with sleep-­disordered breathing).
During the lockdown, 78.9% of participants were confined at home
without working. Most patients (69.6%) reported at least one sleep
difficulty and frequent awakenings was the most prevalent problem
(54.8%). Reporting at least one sleep difficulty was associated with
home confinement without working (OR 2.11, p  =  0.009), female
gender (OR 2.37, p  = 0.001) and diagnosed or suspected SDB (OR
1.69, p  =  0.035), after adjustment for cohabitation status and use
of anxiolytics. Home confinement without working was associated
with difficulties falling asleep (OR 5.21, p < 0.001) and waking up too
early in the morning (OR 2.57, p = 0.003), and showed a positive ten-
dency for frequent awakenings during the night (OR 1.64, p = 0.064).
On the other hand, those who continued to work as usual were more
likely to complain about non-­restorative sleep (OR 4.35, p = 0.029).
Conclusions: Home confinement without working, female gender
and SDB may predict a higher risk of reporting sleep difficulties.
Medical support during major disasters should be strengthened and
potentially delivered through telemedicine, as this comprehensive
approach could reduce psychological distress and improve sleep
quality.
Disclosure: Nothing to disclose.
P450 | The association between shift work
disorder and turnover intention among nurses
K.M. Blytt1,2; B. Bjorvatn2,3; B. Moen4; S. Pallesen2; A.
Harris2; S. Waage2
1
Department of Health and Caring Sciences, Western Norway
University of Applied Sciences, Norway; 2University of Bergen;
3
Haukeland University Hospital; 4University of Adelaide Bergen,
Bergen, Norway
Objectives/Introduction: Nurses’ turnover may have negative im-
pact on the ability to accommodate patients’ needs and to provide
high standards of care. Therefore, it is essential to identify factors
that may affect nurses’ turnover intention. In this study, we aimed to
investigate the association between shift work disorder (SWD) and
turnover intention among nurses.
Methods: Data were derived from the ongoing longitudinal cohort
study ‘SUrvey of Shift work, Sleep and Health (SUSSH)’ among
Norwegian nurses. The study was initiated in 2008/2009 (N = 2965)
and then annually. The present study used data collected in 2015
(wave 7) and 2016 (wave 8). Nurses were included if: (1) they were
working as nurses in 2015 and 2016, and (2) had completed a three-­
item scale adapted from the Michigan Organizational Assessment
Questionnaire assessing turnover intention (in wave 8). SWD was
measured in wave 7 with three questions based on the minimal crite-
ria from the third edition of the International Classification of Sleep
Disorders. Job demands, decision latitude, and social support in the
workplace were measured with subscales of the Swedish Demand-­
Control-­Support Questionnaire.
Results: N  =  1449 nurses were included. Hierarchical multiple re-
gression analyses showed that SWD was associated with high turno-
ver intention one year later (p < 0.01), also when controlling for age,
sex, work experience and support, demand and decision latitude in
the workplace (all p < 0.05). Furthermore, nurses who experienced
low social support at work had higher turnover intention scores
(p < 0.01).
Conclusions: The present study revealed that nurses with SWD
are more prone to seek other job opportunities than those without
SWD, also when controlling for age, sex, job experience, social sup-
port, demands and decision latitude at the workplace.
Disclosure: Nothing to disclose.
ABSTRACTS
P451 | Narcolepsy with cataplexy: does age at
diagnosis change the clinical picture?
1 1 2
M. Zhang ; C.O. Inocente ; C. Villanueva ; M. Lecendreux
Y. Dauvilliers4,5,6; J.S. Lin1; I. Arnulf4,7; M.P. Gustin8,9; M.
Thieux1,4,10; P. Franco1,4,10
1
Integrative Physiology of the Brain Arousal Systems, CRNL,
INSERM-­U1028, CNRS UMR5292, University of Lyon 1;
2
Endocrinology Pediatric Unit, Woman Mother Child Hospital, Civil
Hospices of Lyon, Lyon; 3Pediatric Sleep Centre, Hospital Robert-­
Debre; 4National Reference Centre for Orphan Diseases, Narcolepsy,
Idiopathic Hypersomnia, and Kleine-­Levin Syndrome, Paris; 5Sleep-­
Wake Disorder Unit, Department of Neurology, Gui-­de-­Chauliac
Hospital, CHU Montpellier; 6Inserm U1061, University of Montpellier,
Neuropsychiatry: Epidemiological and Clinical Research, Montpellier;
7
AP-­HP, Pitié-­Salpêtrière Hospital, Sleep Disorder Unit & Sorbonne
8
University, Paris; Emerging Pathogens Laboratory-­Fondation Mérieux,
International Center for Infectiology Research (CIRI), Inserm U1111,
CNRS UMR5308, ENS de Lyon; 9Institute of Pharmaceutic and
Biological Sciences, Public Health Department, Biostatistics, University
of Lyon 1; 10
Sleep Pediatric Unit, Woman Mother Child Hospital, Civil
Hospices of Lyon, Lyon, France
Objectives/Introduction: To compare symptoms and sleep charac-
teristics in patients diagnosed with narcolepsy-­cataplexy (NC) be-
fore and after the age of 18 years.
Methods: De novo patients with NC diagnosis completed a stand-
ardized questionnaire and interview, followed by a sleep study. The
clinical and sleep measures were compared between patients diag-
nosed before (50 children, median age: 12 y old) and after (46 adults,
median age: 28.5 y old) 18 years of age.
Results: In this cohort included 50 de novo childhood patients and
46 adulthood patients, the frequency of obesity (56% vs 17%,
p  =  0.0001), night eating (29% vs 7%, p  =  0.01), parasomnia (86%
vs 43%, p  <  0. 0001), sleep talking (78% vs 34%, p  <  0.0001) and
sleep drunkenness (72% vs 24%, p  <  0.0001 ) were higher in chil-
dren than in adults, the frequency of sleep paralysis was lower (22%
vs 55%, p = 0.003) but the frequency of cataplexy and the severity
of sleepiness were not different. Children scored higher than adults
at the attention deficit/hyperactivity disorder (ADHD) scale (50 vs
26, p < 0.0001). Depressive feelings affected not differently children
and adults (24% vs 32%, p = 0.61). However, adults had lower qual-
ity of life than children (43 vs 63, p  <  0.0001). There was no dif-
ference between groups for insomnia and fatigue scores. Quality of
life was essentially impacted by depressive feelings in both children
and adults. Obstructive sleep apnea index (OAHI) was lower in chil-
dren (0.6 vs 2.3, p = 0.01) with higher mean (97 vs 96, p = 0.02) and
minimal oxygen saturation (93.8 vs 91, p  <  0.0001) than in adults.
No between-­groups differences were found at the multiple sleep la-
tency test. The body mass index (z-­score) tend to be correlated with
OAHI (r = 0.29, p = 0.05).
|
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Conclusions: At time of NC diagnosis, children have more frequent
obesity, night eating, parasomnia, sleep talking, drunkenness and
ADHD symptoms than adults, even if sleepiness and cataplexy
3,4
; do not differ. These differences should be considered to ensure a
prompt diagnosis.
Disclosure: Nothing to disclose.
P452 | Effects of solriamfetol on driving
performance in participants with narcolepsy
F. Vinckenbosch1; G.J. Lammers2,3; S. Overeem4,5; D.
Chen6; G. Wang6; L. Carter6; K. Zhou6; J. Ramaekers1; A.
Vermeeren1
1
Maastricht University, Maastricht; 2Leiden University Medical
Centre; 3Sleep-­Wake Centre SEIN, Leiden; 4Kempenhaeghe, Heeze;
5
Eindhoven University of Technology, Eindhoven, The Netherlands;
6
Jazz Pharmaceuticals, Palo Alto, CA, USA
Objectives/Introduction: Patients with narcolepsy have an in-
creased risk of automobile accidents. Solriamfetol, a dopamine/
norepinephrine reuptake inhibitor, is approved in the EU and US to
improve wakefulness and reduce excessive daytime sleepiness in
adult patients with narcolepsy with or without cataplexy (approved
dose range, 75–150 mg/day). This study evaluated the effects of
solriamfetol on on-­road driving performance in participants with
narcolepsy.
Methods: In each period of this randomised, double-­
blind,
placebo-­
controlled, crossover study (NCT 02806908; EudraCT
2015-­0 03931-­36), driving performance during an on-­road driving
test (a 1-­hour drive on a public highway) was assessed at 2 hours
and 6 hours post-­dose following 7 days of treatment with solriam-
fetol (150 mg/day × 3 days, then 300 mg/day × 4 days) or placebo.
For assessment of driving performance, the primary endpoint was
standard deviation of lateral position (SDLP), a measure of ‘weav-
ing’ (departure from a steady lane position), at 2 hours post-­dose.
Wilcoxon signed rank test was used for comparisons between solri-
amfetol and placebo.
Results: The study included 24 participants (54% male; mean age,
40 years); 22 were included in the analyses of SDLP data. At 2 hours
post-­
dose, SDLP for participants receiving solriamfetol (median,
19.08 cm) was statistically significantly lower than for participants
receiving placebo (median, 20.46 cm; p = 0.0022), indicating better
performance with solriamfetol; 4 participants receiving solriamfetol
and 7 receiving placebo failed to complete the driving test at this
time point. At 6 hours post-­dose, SDLP for solriamfetol (median,
19.59 cm) was not statistically significantly different from that for
placebo (median, 19.78 cm; p = 0.1245); 3 participants receiving sol-
riamfetol and 10 receiving placebo failed to complete the driving test
at this time point. Common adverse events (≥5%) were headache,
decreased appetite, somnolence, sleep disorder, agitation, nausea,
and palpitations.
 |
288 of 356       ABSTRACTS
Conclusions: Solriamfetol (300 mg/day) improved SDLP, an impor-
tant measure of driving performance, at 2 hours after administration
in participants with narcolepsy.
Disclosure: F Vinckenbosch is an employee of Maastricht University.
Maastricht University received financial support to conduct the
present study. GJ Lammers has received consultancy fees and/or
honoraria and has been a speakers’ bureau member and/or an advi-
sory board participant for UCB Pharma, Bioprojet, Theranexus, and
Jazz Pharmaceuticals. S Overeem has received an unrestricted grant
from UCB Pharma for research unrelated to this work. D Chen, G
Wang, L Carter, and K Zhou are employees of Jazz Pharmaceuticals
who, in the course of their employment, have received stock op-
tions exercisable for, and other stock awards of, ordinary shares of
Jazz Pharmaceuticals plc. JG Ramaekers has received grants from
pharmaceutical industries as well as national (NWO, ZonMw) and
international (EU Commission) funding bodies that are unrelated
to this work. A Vermeeren is an employee of Maastricht University.
Maastricht University received financial support to conduct the pre-
sent study.
P453 | Personality traits in children and
adolescents with narcolepsy
E. De Schacht1; L. Quaedackers2,3; S. Overeem2,4; G.J.
Lammers5,6; D. Hendriks7; M.M. van Gilst2,8; P. Amesz5; P.
van Mierlo2; N. Vandenbussche2; S. Pillen2,8; K. Dhondt9,10
1 2
Ghent University, Ghent, Belgium; Sleep Medicine Center
Kempenhaeghe, Heeze; 3Dept. of Industrial Design, Eindhoven
University of Technology; 4Biomedical Diagnostics Group, Eindhoven
University of Technology, Eindhoven; 5Sleep-­Wake Centre SEIN,
Heemstede; 6Leiden University Medical Centre, Leiden; 7Sleep
8
Medicine Center, HMC Westeinde Hospital, The Hague; Department
of Electrical Engineering, Technical University Eindhoven, Eindhoven,
The Netherlands; 9Pediatric Sleep Center; 10
Pediatric Gender Clinic,
University Hospital Ghent, Ghent, Belgium
Objectives/Introduction: The aim is to gain insight in the personality
profile in children with narcolepsy. Narcolepsy is a rare neurologi-
cal, yet chronic disorder. The symptomatology of narcolepsy is often
described as the ‘narcoleptic tetrad or pentad’ with daytime sleepi-
ness, cataplexy and disturbed nocturnal sleep as core symptoms.
However, in children a distinct presentation is frequently perceived,
which potentially hampers diagnosis. Studies on personality traits in
the narcoleptic population are scant. Recurrent findings in studies in
adults are the higher degree of social introversion as well as anxious-
ness and lower scores on socialization scales.
Methods: Parents of 57 paediatric narcolepsy patients and 64
age-­and sex matched healthy control subjects were asked to fill
out the Hierarchical Personality Inventory for Children (HiPIC) and
Dimensional Personality Symptom Itempool (DIPSI).
Results: Data showed a significant disparity in personality profiles
between the narcolepsy group and healthy controls. Subjects in the
narcolepsy group scored significantly lower in all five subdomains of
the HiPIC questionnaire and significantly higher in three of the four
subdomains of the DIPSI questionnaire. This implies that they are
less emotionally stable (mean difference [MD] = 6.9, 95%CI(2.9;10.8),
p = 0.004), less extravert (MD = 20.9, 95%CI(14.9;26.9), p < 0.001),
show less ingenuity (MD = 8.3, 95%CI(3.8;12.8), p = 0.002), display
less benevolence (MD = 21.1, 95%CI(13.3;28.9), p < 0.001) and are
less conscientious (MD = 10.7, 95%CI(4.1;17.4), p  =  0.009) when
compared to control subjects. The preponderance of these observa-
tions was corroborated by the DIPSI analysis. In addition, in the nar-
colepsy group there were differences related to gender: boys were
generally more emotionally stable than girls (unstandardized coef-
ficient [US] = 11.7, p < 0.001) and exhibited less unwilling behaviour
(US = −5.2, p = 0.01). Moreover, participants receiving medication for
the treatment of narcolepsy were less emotionally stable (US = 19.1,
p  =  0.03), more unwilling (US = 33.9, p  =  0.002) and introverted
(US = 10.2, p = 0.003).
Conclusions: The disparity in personality traits between the narco-
leptic and control population is substantial and partially related to
medication use. This indicates that particular attention should be
paid to personality traits and psychosocial functioning when guid-
ing children with narcolepsy in order to ameliorate the quality of life
and general welfare of these patients. Nevertheless, further stud-
ies are needed to assess the influence of these personality traits on
psychiatric comorbidities, psychosocial functioning and treatment
outcome.
Disclosure: Nothing to disclose.
P454 | A case of Narcolepsy type 1 in a patient
with paraneoplastic limbic encephalitis
G. Sallemi1; G.M. Asioli1; S. Rossi1; C. Franceschini2; F.
Pizza1,3; G. Plazzi1,3
1
Biomedical and Neuromotor Sciences Department (DIBINEM),
Bologna, Italy, University of Bologna, Bologna; 2University of Parma,
Parma; 3IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna,
Italy
Objectives/Introduction: Narcolepsy type 1 (NT1) is a chronic hy-
persomnia of central origin linked to the selective damage of hypo-
thalamic hypocretin producing neurons. Secondary NT1 has been
associated with several conditions such as paraneoplastic/autoim-
mune encephalitis, hypothalamic damage. Here we report a case
with NT1 arising in the context of a limbic encephalitis associated
with mediastinal seminoma.
Methods: Clinical, neuroradiological, anatomopathological, biologi-
cal and polysomnographic single patient study.
Results: A 19 year old man developed insomnia, hyperphagia and
sexual dysfunction, rapidly followed by excessive daytime sleepiness
ABSTRACTS
with frequent sleep attacks. Brain MRI showed T2 hyperintense le-
sions involving hypothalamus and optic tracts, cerebrospinal fluid
(CSF) revealed a mild pleocytosis consistent with limbic encephalitis.
Test for anti-­neuronal antibodies were negative, and Total-­body CT
showed a mediastinal mass, which was diagnosed with Mediastinal
Multicystic Seminoma at biopsy. After surgery and chemothera-
peutic treatment, despite neuroradiological findings progressively
disappeared, the patient did not display any significant clinical im-
provement. Clinical and polysomnographic (night-­and continuous
polysomnography and multiple sleep latency test -­MSLT) assess-
ment at 21 year of age disclosed hypersomnia with multiple sleep
onset REM periods, CSF-­hypocretin-­1 was 110 pg/mL, leading to
a NT1 diagnosis. The patient carried the HLA DQB1*0602 allele.
Sodium Oxybate treatment improved nocturnal and daytime symp-
toms. During follow up the patient developed a depressive syndrome
and an obsessive compulsive disorder
Conclusions: Paraneoplastic limbic encephalitis triggered NT1 in
a genetically predisposed patient. Prompt disease recognition and
treatment for narcolepsy could improve patients outcome
Disclosure: Giombattista Sallemi declares he has no conflict of inter-
est. Gian Maria Asioli declares he has no conflict of interest. Simone
Rossi declares he has no conflict of interest. Christian Franceschini
declares he has no conflict of interest. Fabio Pizza declares he has no
conflict of interest. Giuseppe Plazzi participated to advisory board
for Jazz, Bioprojet, and Idorsia.
P455 | Variation of the motor activity profile
according to sleep macro and microstructure in
pediatric type 1 narcolepsy
M. Filardi1; F. Pizza1,2; M. Moresco2; S. Vandi1,2; E. Antelmi3;
G. Plazzi1,2
1
Departement of Biomedical and Neuromotor Sciences, University
of Bologna; 2IRCCS Istituto delle Scienze Neurologiche di Bologna,
Bologna; 3Department of Neurosciences, Biomedicine and Movement
Sciences, University of Verona, Verona, Italy
Objectives/Introduction: Disrupted nighttime sleep (DNS) is a core
symptom of type 1 narcolepsy (NT1), resulting from hypocretin neu-
ronal loss. In this study we quantified the influence of DNS on NT1
children motor activity profile.
Methods: Fifty-­
nine drug-­
naïve NT1 children and adolescents
(age = 12.47 ± 3.56) underwent two weeks of actigraphy immedi-
ately prior to the diagnostic hospitalization. The second PSG night
was analyzed and the following variables extracted: percentage of
N1, N2, SWS and REM sleep, SE and PLMi. For a subsamples of pa-
tients (n = 47) we also computed sleep transitions index including:
a) Wake index, b) NREM/2-­3 to Wake/N1, c) REM/N2/N3 to Wake/
N1 and d) Wake/N1. Activity profiles were processed by mean of
functional linear modeling (FLM) to convert and analyze raw activity
in functional form.
|
      289 of 356
Results: The analysis show that the N1 sleep percentage has a sig-
nificant influence on NT1 children's motor profile with higher per-
centages of N1 sleep being associated with lower motor intensity
between 12:00-­14:00 (critical F < 0.05) and 18:00–20:00 (point-­
wise F < 0.05). Similarly, lower REM sleep percentage is associated
with lower motor activity intensity between 11:00-­13:00 (critical
F < 0.05). On the contrary N2, SWS percentage and sleep transition
index does not significantly influence the motor activity profile.
Conclusions: These findings show that the N1 sleep percentage is
linked to lower daytime activity levels. Combining information deriv-
ing from actigraphy and PSG in a single analytical framework allows
to characterize the effects of DNS on NT1 children's everyday life.
Disclosure: Nothing to disclose.
P456 | Creativity in NT1 patients: clinical
aspects and mental state in the prediction of
creative success
A. D'Anselmo1; S. Agnoli1,2; F. Pizza1,3; M. Filardi1; S.
Mastria1,2; G.E. Corazza1,2; G. Plazzi1,3
1
University of Bologna; 2Marconi Institute for Creativity; 3IRCCS
Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
Objectives/Introduction: Narcolepsy type 1 (NT1) is a chronic neu-
rological disorder characterised by excessive daytime sleepiness
(EDS), with rapid access into rapid eye movement (REM) sleep at
sleep onset. Clinical phenomena related to state of wakefulness and
REM sleep dissociation, including cataplexy, sleep paralysis, hypna-
gogic/hypnopompic hallucinations, REM sleep behaviour disorder
and lucid dreaming complete the clinical picture.
Given the relationship highlighted by several studies between sleep
and creative thinking and considering the features of abnormal
REM sleep phases in narcolepsy, with privileged access to sleep and
dream, a recent study hypothesized and reported higher creative po-
tential in narcoleptic patients compared to a control group.
With this study we aimed at investigating if creativity in narcolepsy
could be associated with certain symptoms and with mental dimen-
sions (such as mind wandering and daydreaming) that could predict
creative behaviour.
Methods: Sixty-­six NT1 patients (mean age 38.62 ± 17.05, 31 fe-
males), took part in this study. Several measures of creativity have
been performed: creativity achievement, explored in different life
domains by a self-­reported questionnaire; creative beliefs, assessed
with a scale measuring the creative self; creative performance, eval-
uated through a test assessing divergent thinking skills (generation
of alternative original solutions to an open problem).
Results: In a mediation analysis we found that sleep paralysis and
hypnagogic hallucinations indirectly influence, through creative
identity, both creative achievement (ß = 0.091, SE = 0.054, 95%
CI = 0.005, 0.211) and creative performance (ß = 0.140, SE = 0.060,
95% CI = 0.034, 0.269). In a moderation analysis mind wandering
 |
290 of 356       ABSTRACTS
spontaneous (R 2 = 0.169, F(3,61) = 4.15, p = 0.009) influences crea-
tive achievement through a moderation effect of sleep paralysis
and hypnagogic hallucinations. The same moderation effect was
found with mind wandering deliberate (R 2 = 0.133, F(3,61) = 3.116,
p = 0.032).
Conclusions: In conclusion, our results highlight the role of sleep pa-
ralysis and hypnagogic hallucinations in defining both creative suc-
cess and creative performance of narcoleptic patients influencing
their creative identity. Probably hypnagogic hallucinations trigger
the process of mind wandering that leads to greater creative success.
Disclosure: Anita D´Anselmo: no conflict of interest Sergio Agnoli:
no conflict of interest Fabio Pizza: no conflict of interest Marco
Filardi: no conflict of interest Serena Mastria: no conflict of interest
Giovanni Emanuele Corazza: no conflict of interest Giuseppe Plazzi:
advisory board for UCB Pharma, Bioprojet, Idorsia.
P457 | Association of sleepiness with diseases
and other sleep complaints among participants of
the ‘Epidemiology of cardiovascular diseases in
regions of Russia (ESSE-­RF)’ study
M. Bochkarev1; L. Korostovtseva1; E. Medvedeva2; O.
Rotar3; Y. Sviryaev1,4; Y. Zhernakova5; S. Shalnova6; A.
Konradi2,7; I. Chazova5; S. Boytsov5; E. Shlyakhto2
1
Somnology Group; 2Almazov National Medical Research Centre;
3
Research Laboratory of Epidemiology of Non-­communicable
Diseases, Almazov National Medical Research Centre; 4Laboratory of
Comparative Somnology and Neuroendocrinology, Sechenov Institute
of Evolutionary Physiology and Biochemistry of Russian Academy
of Sciences, St Petersburg; 5National Medical Research Center for
Cardiology; 6National Medical Research Centre for Therapy and
Preventive Medicine, Moscow; 7ITMO University, St Petersburg,
Russian Federation
Objectives/Introduction: To assess the association of sleepi-
ness with sleep complaints and diseases among participants of
the ‘Epidemiology of cardiovascular diseases in regions of Russia
(ESSE-­RF)’ study.
Methods: Data from participants of the cohort study ESSE-­
RF
(2012-­2013), aged 25–64 years, from 13 regions of the Russia were
analyzed. They were interviewed about sleep complaints: difficul-
ties initiating and maintaining sleep, sleepiness [How often have you
had difficulty refraining from falling asleep when the situation re-
quires it (during work, etc.)?] and sleeping pill intake (response vari-
ants: never, less than once a week, 1–2 times a week, three and more
times a week). Responses with complaints occurring at least three
times a week were considered as insomnia symptoms, and sleepi-
ness as significant. Analyze included anthropometric measures, self-­
reported diseases, laboratory analyses. The final analysis included
20 359 respondents.
Results: Significant frequent (≥3 times a week) sleepiness reported
6.3%, and rare sleepiness (1–2 times/week) – 10.8% respondents.
Sleepiness was not associated with age, physical activity, smoking,
alcohol intake, obesity, hypertension, stroke, myocardial infarction,
parkinsonism, gastrointestinal diseases, thyroid diseases, diabetes
mellitus, and rhythm disturbances. After adjusting for gender, age,
houses type, employment, the odds ratio of frequent sleepiness
increased most significantly with symptoms of insomnia -­frequent
difficulty maintaining sleep [OR 2.44 (95% CI 2.05–2.90) p < 0.05 ],
difficulty falling asleep [OR 2.10 (95% CI 1.78–2.49) p < 0.05], snor-
ing [OR 1.27 (95% CI 1.12–1.44) p < 0.05] and sleep apnea [OR 1.47
(95% CI 1.20–1.78) p  <  0.05], and short sleep -­OR 1.90 (95% CI
1.68–2.16) p < 0.05].
Conclusions: The most significant risk factors for frequent sleepi-
ness In our study are insomnia symptoms -­difficulties maintaining
and initiating sleep. Less significant are the short duration of sleep,
as well as complaints of snoring and sleep apnea.
Disclosure: Nothing to disclose.
P458 | Temperature-­based measurement of
circadian length is associated with depressive
symptoms in adolescent girls
L. Kuula1; J. Lipsanen2; R. Halonen1; A.-K. Pesonen1
1
SleepWell RPU; 2University of Helsinki, Helsinki, Finland
Objectives/Introduction: Circadian regulation is typically compro-
mised in different neuropsychological and psychiatric conditions.
Measuring circadian rhythms objectively has been thus far depend-
ent on high-­frequency sampling protocols, or on deriving measures
from accelerometer data. Here we investigate how a temperature-­
based measure of circadian length differs across adolescents suffer-
ing from depressive symptoms.
Methods: Participants in the study were recruited from a sample of
adolescents (n = 238, 74 % females, mean age 17 y, SD = 0.7). We
measured skin temperature with thermologgers (iButton 1922L),
and calculated the individual circadian length (CL) based on tem-
perature variation.
We additionally calculated sleep midpoint on both weekdays (WK)
and weekends (WE) based on the participants’ responses. A score for
depressive symptoms was summed from Beck Depression Inventory
II (BDI-­II). We analysed girls and boys separately.
Results: Temperature-­based circadian length varied between 20 h
and 28 h. It correlated with BDI-­II scores in girls (r = −0.16, p = 0.04),
indicating higher depressive symptoms in those with shorter circa-
dian length. Additionally, later sleep midpoint on weekends was as-
sociated with higher BDI-­II scores in both girls and boys (r = 0.26,
p < 0.001; r = 0.28; p = 0.03), respectively).
Conclusions: We found that those girls with shorter circadian
length and later weekend sleep midpoint had higher levels of de-
pressive symptoms. These findings highlight the value of individual
ABSTRACTS
physiological measures of circadian rhythms as indicators of symp-
tom severity. Additionally our study gives way to utilizing tempera-
ture measured individual circadian length as a possible clinically
relevant early marker.
Disclosure: Nothing to disclose.
P459 | The acute effects of light on alertness,
cognition, and mood: a systematic review
L. Bjerrum1; E. Visted1; I.H. Nordhus1,2; S. Lindholm
Andersen1; E. Flo-Groeneboom1
1
Department of Clinical Psychology, University of Bergen, Faculty of
2
Psychology, Bergen; Department of Behavioral Sciences in Medicine,
University of Oslo, Oslo, Norway
Objectives/Introduction: Light regulates non-­image forming func-
tions, including acute changes in alertness, cognition, and emo-
tional state. Light administered during the biological night can elicit
acute improvements in alertness, cognitive performance, and mood.
However, studies investigating acute effects during the biological
day remain inconclusive. A systematic review was conducted to pro-
vide an updated overview of the acute effects of light on daytime
alertness, cognition, and mood.
Methods: The study was preregistered in the PROSPERO database
(reg. nr. 158678). Inclusion criteria were 1) reports published be-
tween year 2000 and 2019 in peer-­reviewed journals, 2) experimen-
tal or quasi-­experimental designs, 3) healthy adults (≥ 18  years of
age), 4) interventions manipulating light within 380–740 nm in terms
of spectral distribution and/or intensity, and 5) indices of alertness,
cognition and mood were assessed objectively and/or subjectively
using psychometrically sound methodology. The search was con-
ducted in Embase, Medline, PsychInfo, and Web of Science, employ-
ing carefully designed MeSH-­and search terms.
Results: The search identified 8693 unique publications, of which
25 records were included for data extraction. Eleven studies as-
sessed effects of monochromatic light, with peak wavelengths cor-
responding to blue, green, orange, and red light. Ten studies included
polychromatic light, and eight studies included blue-­enriched light.
Heterogeneity was eminent across studies in important features
including exposure duration (range: 40 sec–7.5 hours), intensity
(20–1700 lux) and time of day. Alertness was measured by electro-
encephalography (k = 6) and with questionnaires (k = 17). Cognitive
performance was assessed using a range of tasks and tests (k = 12;
e.g. n-­back, Go/No-­Go). Mood was measured psychophysiologically
(k = 5; e.g. Heart Rate Variability) and with questionnaires (k = 8).
Acute effects of light on daytime alertness, cognition and mood are
presented and discussed in terms of differential effects of light spec-
trum and intensity. Quality of the studies are discussed, emphasiz-
ing methodology and accuracy of light measurements, and reported
light characteristics, quality of tests measuring alertness, cognition
|
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and mood, and potential confounding effects of season and time of
day.
Conclusions: Results from this systematic review will inform future
research on the acute effects of light on daytime alertness, cogni-
tion, and mood in healthy adult populations.
Disclosure: Nothing to disclose.
P460 | pyActigraphy, an open-­source python
package for actigraphy data visualisation and
analysis
G. Hammad1; M. Reyt1,2; N. Beliy1; M. Baillet1; M. Deantoni1;
A. Lesoinne1; V. Muto1; C. Schmidt1,2
1
GIGA -­CRC In Vivo Imaging; 2Psychology and Neuroscience of
Cognition Research Unit, Faculty of Psychology and Educational
Sciences, Université de Liège, Liège, Belgium
Objectives/Introduction: Actigraphy consists in continuous 24-­hour
movement recordings using small watch-­like accelerometers. As re-
cordings can last several days or weeks, this technique is an adequate
tool for the in-­situ assessment of the locomotor activity and/or the
study of rhythmic patterns and therefore has been used in the field
of sleep and circadian rhythm studies for the past 40 years. However,
the generalization of the findings is made difficult; researchers either
develop home-­made data processing pipeline and/or analysis scripts,
which are time-­consuming, error prone and make the reproducibility
of the analyses difficult, or rely on commercial toolboxes that are not
only costly but inherently biased and act as black boxes. In addition,
cumbersome data preprocessing, such as cleaning, hampers large
scale analyses, which are mandatory for reliable results.
Methods: The package consists in several modules and offers the
following functionalities:
• unified way to read multiple actigraphy file formats;
• automatic cleaning and masking procedure for spurious periods of
inactivity;
• actigraphy data visualisation, potentially overlaid with the differ-
ent periods reported in a sleep agenda if available;
• usual rest-activity rhythm variables used to assess circadian
integrity;
◦ Interdaily stability (IS), Intradaily variability (IV), Relative
Amplitude (RA) as well their variants (ISm, IVm)
◦ transition probability from rest to activity (kRA) and from ac-
tivity to rest (kAR)
◦ sleep regularity index (SRI) and sleep mid-point
• automatic detection of the rest/activity periods (Cole-
Kripke's, Sadeh's, Scripps’, Oakley's, Crespo's and Roenneberg's
algorithms);
• automatic detection of activity onset and offset times;
• signal modelling or decomposition techniques (Fourier or Singular
Spectrum Analysis (SSA), Gaussian kernel smoothing, …);
 |
292 of 356       ABSTRACTS
• advanced analysis (Cosinor, Detrended Fluctuation Analysis,
Locomotor Inactivity During Sleep)
Results: The pyActigraphy toolbox, an open-­s ource python pack-
age for actigraphy data visualisation and analysis, offers function-
alities to automatise data pre-­p rocessing, read large file batches
and implement various metrics and techniques for actigraphy data
analysis
Conclusions: By developing the pyActigraphy package, we not only
hope to facilitate data analysis but also foster research using actim-
etry and drive a community effort to improve this open-­source pack-
age and develop new variables and algorithms.
Disclosure: Nothing to disclose.
P461 | Age as a correlate of subjective and
objective (spectral EEG) measures of
sleepiness
A. Putilov; O. Donskaya
Research Institute for Molecular Biology and Biophysics of the
Federal Research Centre for Fundamental and Translational Medicine,
Novosibirsk, Russian Federation
Objectives/Introduction: Feeling sleepy evolved to motivate the
everyday switch to sleep-­preparatory behaviors prior to habitual
bedtime. Sleep deprivation experiments consistently revealed higher
vulnerability of young rather than old people to adverse effects of
sleep loss. If so, why don't they go to sleep earlier, become sleepier
during the day and nap more frequently than old people? To address
such questions, we tested whether changes in subjective and objec-
tive (spectral EEG) sleepiness measures were associated with age of
sleep deprived people.
Methods: The paid volunteers of experimental studies aged be-
tween 15 and 67 years were deprived from sleep either till the
next morning or till the 2nd day after today (n  =  130 and 48,
respectively).
Results: We found significant associations of age with objective, but
not subjective measures of sleepiness. For instance, the main effects
of the independent factor ‘Age group’ in two-­way rANOVAs (time
of day as repeated measure) were not significant for score on the
Karolinska Sleepiness Scale (F3/126 = 0.769, F2/45 = 0.479 and F2/42
= 0.530 in one-­night deprivation study and in the first and second
days of two-­day deprivation study, respectively, p > 0.05), but they
were significant for, in particular, alpha power (F3/126 = 3.145, F2/45 =
5.319 and F2/42 = 4.960, p < 0.05, p < 0.01 and p < 0.05, respectively).
We also revealed an age-­specific variation in the spectral EEG signa-
ture of moderate sleepiness. For example, the differences between
ages in changes of power densities during sleep deprivation were
evident from the triple interactions between ‘Age group’ and two
repeated measures, time of day and single-­Hz powers from 1 Hz to
16 Hz (F330,7425 = 1.55 and F315,11340 = 1.27 in one-­night study and in
the first day of two-­day study, respectively, p < 0.05).
Conclusions: The motivational function of subjective sleepiness was
not disturbed in older study participants. Subjective and objective
sleepiness measurements might provide different answers to the
question of whether young people are sleepier than old people after
sleep loss. It is necessity to apply somewhat different spectral EEG
indexes of sleepiness in studies of young and old volunteers.
Disclosure: Nothing to disclose.
P462 | Diaphragm electromyography to
estimate respiratory effort: a preliminary study
N. Vandenbussche1; H. Xu2; L. Xu2; C. Ciccarelli2; X. Long2;
S. Overeem1,2; J.P. van Dijk1; M. Mischi2; E. Peri2
1
Centre of Sleep Medicine, Kempenhaeghe, Heeze; 2Electrical
Engineering, Technische Universiteit, Eindhoven, The Netherlands
Objectives/Introduction: The gold standard for measuring respira-
tory effort during sleep is esophageal manometry (Pes), but the use
of this technique is limited due to its invasiveness Here we inves-
tigate diaphragmatic electromyography (EMGdi) as a non-­invasive
potential alternative, in an experimental setting.
Methods: Thirteen healthy volunteers were instructed to breathe
through a tube which was partially obstructed. Resistance to flow was
varied from openings with an area of 3.14 mm2, 7.0 mm2, 12.6 mm2,
19.6 mm2, 22.8 mm2, or no obstruction. Twelve 1-­minute trials (two for
each condition) were recorded. During each trial, Pes was measured
together with the EMGdi using 4 monopolar electrodes positioned on
the 6th intercostal space of the non-­dominant side and a reference on
the sternum. Due to poor quality of the recorded signals, data from 5
subjects were discarded from the analysis. The envelope of the three
bipolar EMGdi signal was compared with Pes in terms of correlation
coefficient R. Respiratory effort was estimated as the area under the
curve (AUC) and peak-­to-­peak amplitude (PP) during the inspiratory
phase. For each respiratory cycle, onset and offset of inspiration were
detected as maximum and minimum values of Pes, respectively.
Results: EMGdi of the three bipolar channels and Pes were mod-
erately correlated (R1 = 0.6 ± 0.1, R 2 = 0.6 ± 0.2 and R3 = 0.6 ± 0.1).
The estimation of the respiratory effort performed with AUC shows
a high correlation (R > 0.7 ± 0.2) between the two methods. On the
contrary, a poor correlation (R < 0.3 ± 0.2) was found in terms of PP.
Conclusions: The correlation between EMGdi and Pes during simu-
lated upper airway obstruction shows the ability of EMGdi to track
respiratory cycles. AUC seems a more promising approach to esti-
mate respiratory effort. Further investigations in patients with OSA
are planned to study the use of EMGdi to measure respiratory effort.
Disclosure: Nothing to disclose.
ABSTRACTS
P463 | Obstructive sleep apnea in Mild
Cognitive Impairment: a comparative study
between Alzheimer´s disease, others impairments
and the control group
A. García1; A. Buigues1; I. Toledo1; J. Aller1; M. Baquero2; A.
Cuevas2; P. Rubio1; E. Gómez1
1 2
Department of Clinical Neurophysiology; Cognitive Disorders Unit,
Department of Neurology, La Fe University and Polytechnic Hospital,
Valencia, Spain
Objectives/Introduction: Prevalence of obstructive sleep apnea
(OSA) is defined by an apnea-­hypopnea index (AHI) > 5 events per
hour of sleep and it depends according to the type of population
studied. The prevalence of OSA over the general population is es-
timated between 9%–38%, being about 60%–80% when in elderly
men. The prevalence of moderate-­severe OSA (AHI > 15) is ranged
from 20% to 49% in the advanced ages.
The objective of the study is to evaluate the presence of OSA in
three different groups.
Methods: A cross sectional and prospective study with a total sam-
ple of 65 subjects divided in three groups: control group (C) (15),
Mild Cognitive Impairment (MCI) (27) and mild cognitive impairment
with Alzheimer´s Disease (AD) (23), between February 2014 and
December 2018, according to the National Institute on Aging and
the Alzheimer´s Association (NIA-­A A) 2011 criteria.
We have valued demographic data, clinical profile, cerebrospinal
fluid biomarkers, also a complete polysomnography has been made,
following AASM 2012 criteria. For statistical analysis we have been
used Chi square test and Yates correction for qualitative data and
T-­student for numerical data.
Results: In AD group (n  =  23) 91% [95% confidence interval (CI),
79.8–100%] of patients have OSA and 78% (95% CI, 61.4–5.1%) have
AHI > 15. In MCI group (n = 27) 85% (95% CI 71.8–98.6%) have OSA
and 63% (95% CI, 44.7–81.2%) have AHI > 15. In C group (n = 15)
73% (95% CI, 51–95%) have OSA and 40% (95% CI, 15.2–64.8%)
have AHI > 15. Statistically significant differences have been found
on prevalence data of OSA and moderate-­
severe OSA between
AD-­C with (p 0.001) and (p 0.0001) respectively. There are statisti-
cally significant differences on age (average 71.3 years in AD group;
66.7 years in MCI and 64.2 years in C) with (p 0.007) between AD-­C
and (p 0.001) between AD-­MCI. No statistically significant differ-
ences have been found on gender, body mass index or cardiovascu-
lar neither lung diseases.
Conclusions: In our sample groups of AD and MCI, the prevalence of
OSA and moderate-­severe OSA is bigger than in control group and it
is also bigger than the prevalence in clinical literature data for elderly
general population.
Disclosure: Nothing to disclose.
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P464 | All-­cause mortality among patients with
obstructive sleep apnea in the region of Łódź,
Poland (2005–2019)
W. Kuczynski1; A. Kudrycka1; A. Małolepsza1; U.
Karwowska1; A. Kuczyńska2; P. Białasiewicz1
1
Department of Sleep Medicine and Metabolic Disorders;
2
Microbiology and Laboratory Medical Immunology, Medical University
of Lodz, Lodz, Poland
Objectives/Introduction: More information is needed about the
mortality in patients with obstructive sleep apnea (OSA). There is no
epidemiological data available in Poland. The aim of this study was to
assess patients’ all-­cause total mortality after the diagnosis of OSA,
and investigate group of patients with sudden premature death.
Methods: We performed a retrospective study on 12485 patients
from Sleep and Respiratory Disorders Centre, Medical University
of Lodz from 2005 to 2019. We analysed retrospectively medical
charts and polysomnography outcomes, and verified all causes of
death among patients.
Results: From 12485 patients admitted to Sleep Laboratory OSA was
diagnosed among 8675 of them (69.48%): 3087 mild (35.59%), 2141
moderate (24.67%) and severe in 3447 (39.73%) of them. Among them
we confirmed 822 deaths: 147 (17.88%) died due to the cancer, 61 of
them due to lung cancer (41.49%), due to cardiovascular events 275
(33.45%): strokes 56 (20.36%), myocardial infraction 36 (13.09%), pul-
monary embolism 11 (4%), chronic heart failure 80 (54.42%); COPD 56
(6.81%); car accidences 7 (0.85%) and suicides 15 (1.82%).
Conclusions: The most common reason of death among OSA patients
is cardiovascular events. Among patients with cancer, lung cancer was
dominant. Sleep lab centre should provide integrated therapy with other
specialist, 2% of all patients committed suicide, which may suggest that
they were referred due to non-­breathing related sleep disorder.
Disclosure: Nothing to disclose.
P465 | Telemonitoring system vs APAP in the
CPAP treatment follow-­up. A cost-­effectiveness
analysis
S.A. Juarros Martínez1,2; P. Andrés Porras2; M. del Olmo
Chiches1; S. Arribas Santos3; I. Muñoz Diez4; A.I. García
Onieva1; A. Mayoral Aguilera5; C. Disdier Vicente6
1
Sleep Respiratory Disorders Unit, Clinical Universitary Hospital; 2Medicine
Toxicology and Dermatology Department, University from Valladolid;
3
Oxigen Salud SL; 4Physioteraphy Unit. Rehabilitation Department, Clinic
Universitary Hospital, Valladolid; 5Oxigen Salud SL, Barcelona; 6General
Respiratory Unit, Clinic Universitary Hospital, Valladolid, Spain
Objectives/Introduction: CPAP is an effective treatment in OSA.
It is necessary an adequate follow-­up to ensure correct efficacy.
APAP is used as a routine method, but it is expensive and patient
 |
294 of 356       ABSTRACTS
displacement is needed. CPAP telemonitored (TM) is a valid, cost-­
effective and alternative method of control. Our objective is to eval-
uate the cost-­effectiveness of a TM system and if it is preferred in
our patients comparing it with an APAP control method.
Methods: Prospective observational study of OSA patients under-
going CPAP treatment needing an ambulatory control test by APAP
(autoSet S9, ResScan, RESMED®). Collected data: filiation/anthro-
pometry, OSA severity baseline, residual sleepiness (rEpworth),
APAP parameters, patient resources to attend the APAP (means of
transport, distance traveled, time spent, travel expenses, work ab-
senteeism). Preference between TM vs APAP. The direct material
costs of performing APAP have been calculated. It has been com-
pared with the material costs if this control had been done using TM
(Airsense 10 Elite, Airview, Oxigen Salud SL). Variable comparison
(Chi2, T-­Student, U-­Mann-­Whitney). Statistical significance p < 0.05.
Results: 100 patients were recruited. Mean age 60.7 ± 12.8 years, 82%
were men. Higher studies in 67%. Active workers 50%. OSA severe
baseline in 68%. Using CPAP for 5.1 ± 4.7 years, rEpworth of 5.9 ± 4.
Patients came to the APAP covering a distance of 39.1 ± 63.4 km, spend-
ing 108 ± 50 minutes and inverting 7.77 ± 13.31€. Absents from work in
29%. 54% of patients preferred TM: 79.6% in secondary and high school
(p 0.018), 63% active workers (p0.026), younger (55.9 vs 66.4 years,
95%CI 5.9-­15.2; p < 0.001), those who traveled a greater distance (16
vs 8 km; p 0.007) and those than spent more money on travel (3.71€
vs 0.38€; p 0.007). 61.1% sensed TM more comfortable (p 0.003). The
APAP means direct costs was higher than the alternative by TM (3.09
vs. 0.48€, 95%CI 2.59–2.64; p < 0.001). The average time of the analysis
and report of TM process, was 35 minutes lower than APAP.
Conclusions: Monitoring CPAP therapy by APAP is expensive in terms
of lost time and economics. Also produces work absenteeism. Patients
prefer TM. TM avoids patients travels and it´s cheaper for the Sleep-­
Unit. About COVID can be an alternative to patients follow-­up.
Disclosure: This study has not received any funding from any public
or private entity. Nothing to disclose.
P466 | Resilience and its moderating role
towards Narcolepsy type 1 impact on personal
relationships, work and quality of life
1 2 1 1
A. Mangiaruga ; C. Zenesini ; A. D'Alterio ; A. Rosetti ; C.
Franceschini3; M. Menchetti4; F. Pizza2,4; L. Vignatelli2; G.
Plazzi4; F. Ingravallo1
1
Department of Medical and Surgical Sciences (DIMEC), University
of Bologna; 2IRCCS Istituto delle Scienze Neurologiche di Bologna,
Bologna; 3Department of Medicine and Surgery, University of Parma,
Parma; 4Department of Biomedical and Neuromotor Sciences
(DIBINEM), University of Bologna, Bologna, Italy
Objectives/Introduction: To investigate the role of resilience with
regard to the narcolepsy type 1 (NT1) impact on personal relation-
ships, work and quality of life (QoL).
Methods: In this cross-­sectional study, 122 NT1 patients (55.7%
F, mean age 39.5 ± 15.3) and 137 subjects without NT1 (58.4% F,
mean age 38.8 ± 13.4) matched for age and sex were included. We
collected socio-­
demographic data, body mass index (BMI), Beck
Depression Inventory (BDI) score, QoL (SF-­36 PCS and MCS scores),
and resilience level (Resilience scale). Multivariate regression models
and the likelihood-­ratio test were used to investigate the role of re-
silience in the relation between NTI and social outcomes.
Results: Compared to those without NT1, patients more likely had
low resilience (38.5% vs 21.2%), and less likely had high resilience
(17.2% vs 32.1) (p = 0.002). Patients were significantly more often
single (47.2% vs 19.7%), inactive (24.1% vs 12.0%), and with lower
PCS (48.3 vs 54.1) and MCS (40.6 vs 47.8) scores. Multivariate re-
gression model (adjusted for age, gender, education, BMI classes,
BDI score > 13) showed a positive association between being single
and NT1 (OR 3.3, CI 95% = 1.9–7.6), with a gradient for the 3 resil-
ience strata: adjusted OR 11.2 (2.4–52.1) for low, 6.5 (1.7–25.3) for
medium, 1.1 (0.3–4.4) for high resilience. For inactivity, there was
no association with NT1, nor evidence of a moderating effect of re-
silience, while the main determining factors were lower educational
level, obesity, and BDI > 13. Lower PCS and MCS were associated
with NT1, obesity, BDI > 13 and lower resilience.
Conclusions: These results suggest that comorbidities have a main
impact on work inability, while the impact of resilience on QoL and
its moderator role with regard to personal relationships indicate re-
silience as a possible target of intervention to support wellbeing of
patients with NT1.
Disclosure: Plazzi participated to advisory board for Jazz, Bioprojet,
and Idorsia. The other authors have nothing to disclose.
P467 | Within-­subject variations of sleep (mis)
perception in a placebo-­controlled medication
study
L. Hermans1; M. Regis2; P. Fonseca3; S. Overeem1,4; T.
Leufkens3; A. Vermeeren5; M. van Gilst1,4
1
Electrical Engineering; 2Department of Mathematics and Computer
Science, Eindhoven University of Technology; 3Philips Research,
Eindhoven; 4Sleep Expertise Center Kempenhaeghe, Heeze;
5
Department of Neuropsychology and Psychopharmacology, Faculty of
Psychology and Neuroscience, Maastricht University, Maastricht, The
Netherlands
Objectives/Introduction: People with insomnia often overestimate
their sleep onset latency (SOL) compared to objective sleep record-
ings. Previous research results suggest that sleep fragmentation at
the beginning of the night influences the perception of the SOL.
Recently, we introduced a model quantifying the relationship be-
tween sleep fragmentation and sleep onset (mis)perception. Here,
we applied this model on sleep recordings from a within-­subject
placebo-­controlled medication study, to examine whether the effect
ABSTRACTS
of zopiclone on sleep (mis)perception can be attributed to predict-
able alterations in sleep fragmentation at the beginning of the night.
Methods: We analyzed polysomnographic recordings from a double-­
blind, placebo-­
controlled crossover design, with three groups
(insomnia patients chronically using hypnotics, N = 15; insomnia pa-
tients infrequently using hypnotics, N = 16; healthy controls, N = 15).
The experimental intervention was a single oral dose of zopiclone
7.5 mg. The amount of sleep onset misperception was calculated as
the difference between objective and subjective SOL. Subsequently,
we divided sleep onset misperception into a component explained
by sleep fragmentation, calculated as subjective SOL estimated by
the model, and an unexplained component, represented by the re-
sidual error of the model. Multi-­way ANOVA was used to assess the
influence of group and treatment on the amount of misperception,
estimated SOL, and residual error.
Results: A significant effect of group and treatment was found for
the amount of misperception (Group F = 6.1, p  <  0.01, Treatment
F = 10.8, p < 0.001, Group × Treatment F = 2.5, p = 0.089). The amount
of misperception was smaller during the zopiclone night. Post-­hoc
analyses indicated that healthy controls had less misperception com-
pared to both frequent users (W = 652, p = 0.016) and infrequent
users (W = 587.5, p = 0.021). The estimated subjective SOL was sig-
nificantly affected by treatment (Group F = 3.6, p = 0.031; Treatment
F = 16.0, p = < 0.001, Group × Treatment F = 1.0, p = 0.377), and was
shorter during the zopiclone night. No significant effects were found
for the residual error (Group F = 1.6, p = 0.204; Treatment F = 0.203,
p = 0.654; Group × Treatment F = 1.0, p = 0.368).
Conclusions: The unexplained component of sleep onset mispercep-
tion possibly includes psychological traits, time estimation ability
and hyperarousal. Because the residual error did not change be-
tween test conditions, we conclude that zopiclone influenced sleep
onset misperception largely by means of predictable changes of
sleep architecture.
Disclosure: This work has been done in the IMPULS framework of
the Eindhoven MedTech Innovation Center (e/MTIC, incorporat-
ing Eindhoven University of Technology, Philips Research, Sleep
Medicine Center Kempenhaeghe). The funders had no role in the
study design, decision to publish, or preparation of the manuscript.
Philips provided support in the form of a salary for authors T.L. and
P.F., but did not have any additional role in the study design, data
collection and analysis, decision to publish, or preparation of the
manuscript. This activity is in part funded by the PPS program re-
search and innovation of the Dutch ministry of Economic affairs and
Climate.
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P468 | False memory formation is enhanced in
insomniacs compared to good sleepers
S. Malloggi1; F. Conte2; A. Coppola2; O. De Rosa2; G.
Gronchi1; S. Righi1; F. Giganti1; G. Ficca2
1
NEUROFARBA, University of Florence, Florence; 2Psychology,
University of Campania -­Luigi Vanvitelli, Caserta, Italy
Objectives/Introduction: Recent studies suggest that sleep can im-
pact false memory formation. Specifically, acute sleep loss has been
shown to promote false memory production by impairing retrieval
processes at immediate recall. Surprisingly, the topic has only been
investigated in healthy subjects but not in sleep-­disordered popu-
lations. Aim of this study is to compare false memory formation
between insomniacs and good sleepers, also addressing possible dif-
ferences in stimulus processing according to category (neutral vs.
sleep-­related), reported in previous studies.
Methods: Twenty-­five insomniacs (13 Males; age: 25.2 ± 4.3) and 28
good sleepers (11 Males; age: 24.1 ± 3.2) were administered the clas-
sical Deese-­Roediger-­McDermott (DRM) paradigm. Subjects com-
pleted a free recall task after listening to 4 word lists, each made up
of 15 words, semantically related to a non-­presented critical word.
To control for primacy and recency effects, the 2 experimental lists
(one neutral and one sleep-­related, administered in balanced order
between subjects) were presented in between 2 neutral lists, which
were not included in data analysis. A subsample (16 insomniacs, 11
good sleepers) also underwent cognitive testing (Digit span and
Arithmetic subtests of the WAIS, Stroop task, Source-­Monitoring
Test) to assess executive functioning.
Results: False memory formation was globally higher in insomni-
acs than good sleepers (U = 247.0; p = 0.04); moreover, insomniacs
produced more false recalls (U = 254.0; p = 0.04) and fewer veridi-
cal memories (U = 242.5; p = 0.05) than good sleepers at the sleep-­
related list. An influence of stimuli also emerged when comparing
the two lists within groups: insomniacs produced fewer veridical
memories at the sleep-­related vs. neutral list (Z = -­2.59; p  =  0.01)
whereas no differences between lists were observed in good sleep-
ers. No between-­groups differences emerged at cognitive testing.
Conclusions: Our findings show that false memory production is en-
hanced in insomniacs compared to good sleepers. Although a link
of this effect to impaired executive functioning is not supported by
our data, it should be further explored in a larger sample. Also, false
memory production appears modulated by stimulus category in in-
somniacs, in line with previous literature pointing to a differential
processing of sleep-­related vs. neutral stimuli in this population.
Disclosure: Nothing to disclose.
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296 of 356       ABSTRACTS
P469 | A neurophysiological and
neuropsychological assessment in insomniacs
with severe abuse of benzodiazepines
S. Miano1; R. Ferri2; M. Maestri3; V. Bottasini4; M. Anelli4; M.
Zucconi4; V. Castronovo4; L. Ferini-Strambi5; M. Manconi1
1
Sleep and Epilepsy Center, Neurocenter of Southern Switzerland,
Civic Hospital of Lugano (EOC), Lugano, Switzerland; 2Sleep Research
Centre, Department of Neurology I.C., Oasi Research Institute for
Research on Mental Retardation and Brain Aging-­IRCCS, Troina;
3
Department of Neurosciences, Neurological Clinic, University of Pisa,
Pisa; 4Sleep Disorders Center; 5Sleep Disiorders Center, Vita-­Salute
San Raffaele University, Milan, Italy
Objectives/Introduction: Abuse and dependence on high doses of ben-
zodiazepines (BZD) is a relevant issue in patients with chronic insomnia.
The aim of this study was to evaluate the cognitive profile in a group of
long-­term users of high doses of BZDs for primary chronic insomnia.
Methods: Consecutively patients admitted at the Sleep Centre for
drug discontinuation and matched healthy controls underwent a full
neuropsychological battery and event-­related potentials (ERP) fo-
cusing on P-­300 and Mismatch Negativity (MMN) components.
Results: Seventeen patients (7M, 10F, mean age 49.2 ± 11.2 years)
and 17 matched controls (7M, 10F, mean age 46.8 ± 14.1 years)
completed the study, without significant differences for age, gender
or education. The mean diazepam-­equivalent BDZ dosage taken by
patients was 223.9 ± 312.2 mg. Patients showed significant impair-
ment of cognitive abilities and executive function as showed by Mini
Mental State Examination, semantic and phonetic verbal fluency and
trail making test, Rey Osterrieth complex figure Recall and Cognitive
Estimation Test. In patients an amplitude reduction of P300 was
found, higher in frontal regions.
Conclusions: This study demonstrates a significant impairment of
executive functions in a sample of insomniacs with a chronic use of
high dosage of BDZ. The strength of the study is that patients in-
vestigated reflect a condition similar to real-­life, for the long term
treatment with BDZ that is common in clinical practice.
Disclosure: Nothing to disclose.
P470 | Night work as a stressor -­role of sleep
reactivity to stress in the relationship between
night work and insomnia
K. Gustavsson1; A. Wichniak1,2
1
Department of Clinical Neurophysiology, Sleep Medicine Center;
2
Third Department of Psychiatry, Institute of Psychiatry and Neurology,
Warsaw, Poland
Objectives/Introduction: Sleep reactivity to stress is a predispo-
sition to experience sleep disturbances in response to stress. The
present study aimed to examine the potential moderating role of
sleep reactivity to stress in the relationship between number of
night shifts per month as a stressor and insomnia symptoms.
Methods: A total of 188 shift working physicians participated in this
study and completed a short questionnaire about work schedule, the
Ford Insomnia Response to Stress (FIRST) and the Insomnia Severity
Index.
Results: The interaction of number of night shifts and FIRST was
statistically significant (B = −0.0635, SE = 0.0227, p = 0.0057) in our
model, indicating that sleep reactivity to stress was a significant
moderator of the effect of number of nights worked last month on
insomnia symptoms. The interaction effect accounted for 3.13%
added variation in insomnia. At the low sleep reactivity to stress
(−1SD) and medium sleep reactivity to stress (at the mean) the re-
lationship between number of night shifts per month and insomnia
symptoms was positive and significant (low -­B = 0.7725, SE = 0.1980,
p = 0.0001; medium -­B = 0.4221, SE = 0.1498, p = 0.0054). At the
high sleep reactivity to stress (+1SD) the relationship was no longer
significant (B = 0.0718, SE = 0.1924, p  =  0.7095). The relationship
between number of night shifts and insomnia symptoms was signifi-
cant up until 25.9 on FIRST (p's ≤ 0.05).
Conclusions: The results show that with low and medium sleep reac-
tivity to stress, the more night shifts a person works per month the
more severe insomnia symptoms they will report. With high sleep
reactivity to stress the number of night shifts per month does not
matter and any number will lead to a deterioration of sleep. This is
important for identifying those who are more vulnerable to adverse
consequences of working in the shift system and the knowledge of
workers’ sleep reactivity to stress may help in providing targeted
interventions.
Disclosure: The research is supported by a grant no. 2019/33/N/
HS6/02572 from the National Science Center in Poland.
P471 | Personality, cognitive emotion
regulation processes and insomnia in young
adults
S. Carvalho Bos1; A.P. Amaral2; M.J. Soares1; A.T. Pereira1;
M. Marques1; N. Madeira1; V. Nogueira1; M. Bajouco1; A.
Macedo1
1
Institute of Psychological Medicine, Faculty of Medicine, University of
Coimbra; 2Coimbra Health School, Polytechnic Institute of Coimbra,
Coimbra, Portugal
Objectives/Introduction: Insomnia and negative affect are common
in young adults and have a negative impact on daily functioning. The
aim of this study was to investigate associations between person-
ality traits, perceived stress, repetitive negative thinking, cognitive
emotional regulation difficulties and insomnia, controlling the effect
of negative affect.
ABSTRACTS
Methods: A total of 549 college students (M = 20.5 ± 4.83 years),
mostly female (80.1%), participated in the study and completed a set
of questionnaires: Eysenck Personality Inventory, Multidimensional
Perfectionism Scales, Perceived Stress Scale, Perseverative Thinking
Questionnaire, Cognitive Emotion Regulation Questionnaire, Profile
of Mood States and the Insomnia Inventory. Comparisons between
sleep groups (insomnia group, insomnia symptoms group and good
sleepers) were performed using the statistical analysis of ANOVA
followed by Tukey HSD or Tamhane`s tests, used as appropriate (sta-
tistical significance was set at p < 0.05).
Results: When the effect of negative affect was controlled for we
observed that the insomnia group (individuals with insomnia symp-
toms and associated daytime impairment), in comparison with good
sleepers, reported higher scores in personality traits of neuroticism
(M = 12.3 ± 1.81 versus M = 10.0 ± 1.98, p  <  0.001) and socially
prescribed perfectionism (M = 49.1 ± 9.61 vs. M = 44.1 ± 9.79, p =
0.007), reported experiencing a more stressful life (M = 21.4 ± 4.33
vs. M = 16.2 ± 4.95, p < 0.001), used more frequently perseverative
repetitive negative thinking to cope with problems or negative life
events (M = 28.8 ± 8.51 vs. M = 22.7 ± 7.89, p < 0.001) and used ru-
mination as a cognitive emotional regulation strategy to cope with a
negative past event (M = 15.1 ± 4.32 vs. M = 12.8 ± 3.52, p = 0.004).
Conclusions: Neuroticism, socially prescribed perfectionism, stress
reactivity, repetitive negative thinking and rumination were psycho-
logical factors associated with disturbed sleep and insomnia in uni-
versity students.
Disclosure: Nothing to disclose.
P472 | Altered functional connectivity in
insomnia disorder
K.V. Jespersen1; A. Stevner2; M. Kringelbach3; E. Van
Someren4,5; D. Vidaurre2; P. Vuust1
1
Department of Clinical Medicine, Center for Music in the Brain;
2
Department of Clinical Medicine, Center for Functionally Integrative
3 3
Neuroscience, Aarhus University, Aarhus, Denmark; Department of
4 4
Psychiatry, University of Oxford, Oxford, UK; Netherlands Institute
for Neuroscience; 5Departments of Integrative Neurophysiology
and Psychiatry, VU University and Medical Center, Amsterdam, The
Netherlands
Objectives/Introduction: Insomnia disorder (ID) is the most preva-
lent sleep disorder, and an increasing number of studies aim to shed
light on the neural underpinnings of ID to ultimately facilitate the
development of better treatment. Resting-­state functional connec-
tivity can contribute with an increased understanding of how the
patterns of neural activity may be altered in ID, but researchers have
only just begun to look at the temporal structure of these functional
networks, i.e. how they fluctuate over time. In this study, we as-
sessed alterations of functional connectivity in ID using both static
and time-­varying methods.
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Methods: We analyzed resting-­state fMRI data of 29 participants;
15 with Insomnia Disorder and 14 matched good sleeper controls
resting in the scanner with eyes open. Data were pre-­processed
using FSL MELODIC and we used ICA for artefact rejection. Group
differences in static functional connectivity were assessed with
network-­based statistics and Hidden Markov modelling was used
for time-­varying analyses.
Results: Compared to controls, participants with ID showed in-
creased functional connectivity in a network including the right infe-
rior parietal lobule, the right inferior frontal operculum and the left
caudate as the most connected regions (NBS t-­thresh = 3.6, p < 0.05).
Preliminary time-­varying analyses revealed group differences also in
the temporal dynamics of the neural networks. These results will be
presented and discussed at the conference.
Conclusions: Alterations in large-­
scale functional networks have
been associated with insomnia disorder, and in this study we find
increased activity in a brain network involving the right inferior
parietal lobule and the right inferior frontal operculum. Both these
regions are crucial for controlling attention and responding to sali-
ent stimuli in the environment. Thus, the results seem to correspond
well with the hyper-­arousal theory of insomnia. In addition, the net-
work of increased activity also included the left caudate which has
previously been associated with insomnia. The time-­varying analy-
ses can give additional insight into the temporal properties of the
brain dynamics underlying insomnia disorder.
Disclosure: Nothing to disclose.
P473 | Sleep health and brain morphometry in
the UK Biobank
J.E. Schiel1; S. Tamm2,3; C.E. Sexton3,4; B. Feige1; D.
Riemann1; M.K. Rutter5,6; S.D. Kyle7; K. Spiegelhalder1
1
Department of Psychiatry and Psychotherapy, Medical Center,
University of Freiburg, Freiburg im Breisgau, Germany; 2Department
of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden;
Department of Psychiatry, University of Oxford, Oxford, UK;
Department of Neurology, University of California, San Francisco,
CA, USA; 5School of Medical Sciences, University of Manchester;
6
Manchester Diabetes Centre, Manchester University NHS Foundation
Trust, Manchester; 7Nuffield Department of Clinical Neurosciences,
University of Oxford, Oxford, UK
Objectives/Introduction: Sleep is a complex physiological process
regulated by various brain circuits and neurotransmitter systems.
Empirical research has clearly demonstrated that different aspects of
sleep health are related to future morbidity and mortality. However,
it is unclear whether neurostructural abnormalities underlie dif-
ferent aspects of sleep health. Several small-­scale cross-­sectional
case-­control studies have supported this hypothesis; however, the
results so far are somewhat inconclusive. Thus, in light of recent
doubts about replicability and low power in neuroimaging studies,
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298 of 356       ABSTRACTS
the current study seeks to investigate the independent associations
between several sleep health variables and brain morphometry in a
large sample of individuals of the UK Biobank (UKBB, current results
are based on a sample of n = 16,704; results presented in Sevilla will
be based on an updated sample of n = 39,691).
Methods: Cross-­sectional data from the UK Biobank (Sudlow et al.,
2015) was analyzed using multiple linear regression models with
sleep health variables (insomnia symptoms, sleep duration, daytime
sleepiness and chronotype) as concurrently included independent
variables. Covariates comprised sleep medication use, psychophar-
macological treatment, socioeconomic status, depressive symptoms
and sleep apnoea. Dependent variables were regional grey matter
volumes of 139 brain areas.
Results: All analyses were based on a Bonferroni-­adjusted signifi-
cance level. Short sleep duration was found to be associated with re-
duced grey matter volume in the right precuneus (−0.7%, p = 0.0003)
and increased grey matter volume in the 10th lobule of the cerebel-
lar vermis (+1.3%, p = 0.0001). No other sleep health variables were
related to brain morphometry.
Conclusions: The current results suggest a negative association be-
tween subjective short sleep duration and grey matter volume in
the right precuneus -­and a positive association between subjective
short sleep duration and grey matter volume of the 10th lobule of
the cerebellar vermis. The former finding might be related to altered
DMN connectivity in patients with short sleep duration. However,
further sleep health variables like insomnia symptoms and daytime
sleepiness were not associated with changes in brain morphometry.
Disclosure: Nothing to disclose.
P474 | Different skin phosphorylated alpha-­
synuclein deposition predicts phenoconversion
in isolated rapid-­eye-­movement sleep behaviour
disorder (iRBD)
F. Biscarini1; E. Antelmi2; V. Donadio1; F. Pizza1; A. Incensi1;
R. Liguori1; G. Plazzi1
1 M. Kliková1,2; E. Miletínová1,2; M. Piorecký1,3; K. Janků1,2; D.
University of Bologna, IRCCS Institute of Neurological Sciences,
Bologna; 2Univeristy of Verona, Verona, Italy
Objectives/Introduction: To describe the potential role of skin bi-
opsy in predicting phenoconversion in patients with isolated rapid-­
eye-­movement (REM) sleep behaviour disorder (iRBD).
Methods: Two cases with the suspect of RBD underwent video-­
polysomnography (V-­PSG), skin biopsy for intraneuronal phospho-
rylated alpha-­synuclein (P-­A-­SYN) deposits, 123I-­FP-­CIT-­SPECT ,
Brief Mental Deterioration Battery, and periodical clinical assess-
ment. Patients were followed-­up for 2 and 3 years, respectively.
Results: A 68 years old male (Patient1) presented sleep related
motor behaviours resembling enacted dreams since 64 years old. V-­
PSG confirmed RBD. Skin biopsy documented P-­A-­SYN deposits in
somatic neurons. 123I-­FP-­CIT-­SPECT, neuropsychological tests and
cerebrospinal fluid were unremarkable, brain magnetic resonance
imaging showed signs of early atrophy in posterior cranial fossa
structures. In the following months mild gait imbalance and writing
impairment, erectile dysfunction and increased urinary frequency
appeared. Subsequent neurologic and neuropsychological evalu-
ations showed nystagmus, dysarthria, mild signs of limb and gait
ataxia and mild transient orthostatic hypotension.
A 61 years old male (Patient2) presented for several years with
symptoms suggestive of RBD and orthostatic tremor. In his thir-
ties, he had suffered multiple subarachnoid haemorrhages due to
aneurysms, successfully surgically treated. RBD was confirmed by
V-­PSG. Skin biopsy evidenced P-­A-­SYN deposits in autonomic neu-
rons. 123I-­FP-­CIT-­SPECT highlighted reduced enhancement in both
putamen, then extended to left caudate at follow-­up exam, when
the patient also developed urinary urgency, erectile dysfunction,
and neurological examination displayed mild parkinsonism signs,
subtle postural tremor and postural instability. Neuropsychological
tests were within normal range. He begun treatment with levodopa,
with benefit on rigidity and bradykinesia, but neither on the postural
instability nor on the orthostatic tremor.
Conclusions: The two different cutaneous intraneuronal P-­A-­SYN
patterns associate with iRBD heralded two phenotypic evolutions
of RBD. Patient1, with P-­A-­SYN deposition in somatic skin neurons,
developed a cerebellar syndrome and autonomic failure suggestive
of possible multiple system atrophy. Patient2, carrying P-­
A-­
SYN
accumulation in autonomic skin neurons, converted to possible
Parkinson's disease with signs of dysautonomia. Skin biopsy could
represent a useful tool to predict phenotypic conversion of patients
with iRBD.
Disclosure: F. Biscarini, E. Antelmi, A. Incensi, F. Pizza, V. Donadio
and R. Liguori declare they have no relevant conflict of interest. G.
Plazzi participated to advisory board for Jazz, Bioprojet and Idorsia.
P475 | Polysomnographic parameters in
recurrent isolated sleep paralysis
Urbaczka Dudysová1,2; J. Bušková1,2
1
National Institute of Mental Health, Klecany; 23rd Faculty of
Medicine, Charles University; 3Faculty of Biomedical Engineering,
Czech Technical University, Prague, Czech Republic
Objectives/Introduction: Isolated sleep paralysis (ISP) is a rapid eye
movement (REM) parasomnia characterized by an inability to move
at sleep onset or upon awakening. It is consider to be a dissociative
state between REM sleep and wake. Pathophysiology of ISP is still
unknown. There is a lack of polysomnographic (PSG) studies with
incongruent results. Our goal is to determine differences in macro-
structural and microstructural parameters of PSG recordings and
subjective measures of mood and sleep parameters.
ABSTRACTS
Methods: 38 participants were recruited into our study (19 partici-
pants with at least 2 episodes of ISP in last 6 months, 19 healthy
participants with no history of ISP). Each participant underwent 2
subsequent video-­
polysomnography recordings (adaptation and
experimental night) including 19-­channel electroencephalography
(EEG) electrooculography (EOG), electromyography of chin mus-
cles and lower limb muscles (EMG), electrocardiography (ECG).
Participants with ISP experience underwent multiple sleep latency
tests to exclude narcolepsy. Beck Depression Inventory II (BDI II)
and Beck Anxiety Inventory (BAI) were used to assess level of de-
pression and anxiety.
Results: No ISP episode was recorded during experimental night.
Participants were not different in depression, and anxiety level. In
polysomnographic parameters we found statistically significant dif-
ference only in NREM 3 latency (p = 0.005), with longer NREM3 la-
tency in ISP group (M = 15.35 min) as compared to control group
(M = 10.72 min). We found no difference in sleep latency, sleep ef-
ficiency, WAKE %, REM %, REM latency, NREM1 %, NREM1 latency,
NREM2 %. NREM 2 latency, NREM %. Spectral analysis in REM
sleep reveal higher bilateral beta activity in frontal area under F3
(p = 0.049) and F4 (p = 0.039) electrodes in participants with ISP. No
between groups changes were found in alpha and theta range.
Conclusions: This is the first study concerning both macro-­and mi-
crostructure of REM sleep in participants with ISP. We found longer
NREM 3 latency in participants with recurrent ISP episode and no
other differences in macrostructural PSG parameters. Spectral
analysis reveal higher frontal brain activity in beta range. Further
research in microstructural parameters is necessary to elucidate
pathophysiology mechanisms of ISP.
Disclosure: Nothing to disclose.
P476 | The ‘Ikelos-­Rating Scale’ (Ikelos-­RS):
description and validation of a new instrument
to measure manifestation and change of RBD
symptoms over time
S. Stotz1,2; B. Frederik1,2; D. Kunz1,2
1
Clinic for Sleep-­& Chronomedicine, St. Hedwig-­Krankenhaus;
2
Institute of Physiology, Charité -­Universitätsmedizin Berlin, Berlin,
Germany
Objectives/Introduction: Existing instruments for evaluation of REM
sleep behavior disorder (RBD)-­severity are polysomnographic (PSG)
based, thus are mostly used at the time of diagnosis only. In contrast
to REM-­and motor activity suppressing medications, substances like
melatonin have a gradual and outlasting effect. Therefore an exter-
nal evaluation form to document the initial state before the begin-
ning of treatment and also specific symptom changes in the course
of the disease has been developed.
Methods: The ‘Ikelos-­Rating Scale’ (Ikelos-­RS) is completed by a
clinician based on interviews with patient's bed partner only with
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regard to the last 6 months. On the first scale ‘frequency’, occur-
rence of symptoms is estimated from never (=0) to daily (=4). The
second scale ‘expression’ describes the form of the most severe
manifestation of RBD symptoms from speech or slight distal move-
ments (=0) to leaving the bed (=3). Both ratings are added to a total
score (range 0–7).
Results: In a cohort of iRBD patients (N = 151) treated with mela-
tonin (average follow-­up: 4.1 ± 3.1 yrs after diagnosis) 1153 Ikelos-­RS
were examined at baseline (PSG) and at every check up in further
treatment. For evaluating convergent validity, Ikelos-­RS total score
was correlated with the Clinical Global Impression -­Severity (CGI-­
S) in 1153 cases. For analysis of interrater reliability, 45 Ikelos-­RS
were filled out by two independent physicians. 174 Ikelos-­RS were
filled out again by the same physician after at least six months to rate
test-­retest reliability. Overall, correlation analyses provide evidence
for excellent convergent validity (ρ = 0.9, p < 0.001), interrater reli-
ability (ρ = 0.9, p < 0.001) and test-­retest reliability (ρ = 0.9, d = 0.7,
p < 0.001). For further analysis, scoring of REM sleep without atonia
(RSWA) and video material of PSG will be evaluated and related to
the Ikelos-­RS.
Conclusions: The Ikelos-­RS is an objective, reliable and valid easy-­to-­
use instrument. It allows to document RBD symptom changes over
time via clinical interview, adding to existing instruments that need
PSG based evaluation of RBD symptom severity.
Disclosure: Nothing to disclose.
P477 | Prevalence and characteristics of sleep
paralysis in the Italian University students
C. Colombo1; N. Cellini1,2,3
1
Department of General Psychology; 2Department of Biomedical
Sciences; 3Padova Neuroscience Center, University of Padova, Padova,
Italy
Objectives/Introduction: Sleep paralyses (SP) are parasomnias of
REM sleep, characterized by the inability to perform involuntary
movements. They can take place while falling asleep or while waking
up. It is a relatively widespread phenomenon in the general popula-
tion and, although usually not dangerous, it experienced by intense
fear. According to the literature, on average it starts emerging during
adolescence or early adulthood. The current study aims to evaluate
the lifetime prevalence and characteristics of the phenomenon in
the Italian student population.
Methods: The study was conducted online, through an online bat-
tery of questionnaires. The Unusual Sleep Experience Questionnaire
was used to investigate the prevalence of the disorder as well as
assess the typical symptoms, past and current metacognitive be-
liefs on the episodes, and previous distress factors. The State-­Trait
Anxiety Inventory Form-­Y, the Beck Depression Inventory-­II, the
Pittsburgh Sleep Quality Index, and the reduced version of the
 |
300 of 356       ABSTRACTS
Morningness-­Eveningness Questionnaire were used to assess the
other personal characteristics.
Results: Four-­
hundred and nine students (M = 93; F = 132,
Other = 5, Mage = 22 ± 4.49 y) participated in the study. The 39%
of them (n = 167) reported having had at least one SP episode. The
most recurrent somatic sensation reported during sleep paralysis
is the inability to speak or ask for help (80%), followed by feeling
numb (77%), and the inability to open the eyes (69%) consistent
with REM muscle atonia. Regarding cognitive sensations, the most
recurrent is the feeling that someone is in the room (61%) followed
by the fear of dying (58%) and feelings of being outside the body
(55%). Participants who reported SP had higher scores on anxiety
(p = 0.005), reported worse quality of sleep (p = 0.002), and reported
higher depressive symptomatology (p = 0.038) compared to non-­SP
participants. Participants with SP were more commonly associated
with evening types and less with morning types (p = 0.030).
Conclusions: Results show that SP are generally widespread in the
student population, in line with the prevalence reported for the
general population, and tend to have higher levels of anxiety and
depression, and word sleep quality than those who have never expe-
rienced sleep paralysis.
Disclosure: Nothing to disclose.
P478 | Neuropsychological and behavioral
profile of patients with sleep-­related hypermotor
epilepsy (SHE) and patients with disorders of
arousal (DOA)
M. Figorilli1; P. Pisanu2; M.G. Mascia2; R. Lecca1; G. Gioi1; P.
Congiu1; L. Tamburrino1; M. Puligheddu1
1
Sleep Disorder Center, Dept of Public Health & Clinical and Molecular
Medicine, University of Cagliari; 2Neurorehabilitation Unit, PO SS
Trinità ASSL Cagliari ATS, Cagliari, Italy
Objectives/Introduction: We aimed to compare the neuropsycho-
logical and behavioral profile of patients with sleep-­related hyper-
motor epilepsy (SHE) and disorders of arousal (DOA), together with
sleep macrostructure features. SHE and DOA are two distinct dis-
ease that share in common increased sleep instability and decreased
sleep quality.
Methods: A total of 11 subjects with DOA (3 males, mean
age 32.3 ± 10.9 years) and 12 subjects with SHE (6 males,
33.5 ± 15.2 years) were enrolled at the Sleep Center and the
Epilepsy Center of the University of Cagliari. SHE and DOA diag-
nosis was made according to standard diagnostic criteria. All sub-
ject were not taking any medications. All participants underwent a
video-­polysomnographic (vPSG) recording at sleep lab, according
to standard procedures. Subjective sleep quality was assessed by
means of Pittsburgh Sleep Quality Index (PSQI). All subjects under-
went a comprehensive neuropsychological and behavioral assess-
ment, including evaluation of global cognitive functions, long-­term
verbal memory, visuo-­constructional abilities, cognitive flexibility
and non-­verbal reasoning, selective attention, inhibition and pro-
cessing speed, visuo-­spatial abilities, abstract reasoning. Behavioral
evaluation included assessment of depression and anxiety.
Results: SHE and DOA diagnosis was confirmed by vPSG according
to current diagnostic criteria. No significant differences were found
between the two groups in terms of education, age and gender
distribution. SHE patients reported a significant worse subjective
sleep quality (p = 0.001) and objective sleep efficiency (p = 0.004)
compared to DOA patients. SHE patients were significantly more
depressed than patients with DOA (p = 0.01). Concerning cognitive
functions, patient with SHE performed significantly worse in short-­
term verbal memory (p = 0.003) and verbal learning (p = 0.002) com-
pared to patients with DOA.
Conclusions: SHE patients showed significantly worse cognitive per-
formances, namely in short-­term verbal memory and verbal learning,
and depressive symptoms compared to DOA patients. Moreover,
SHE patients reported worse subjective and objective sleep quality
compared to DOA patients. Thus, SHE is associated with more sig-
nificant sleep disruption that might be associated with increased risk
of depression and cognitive dysfunction, compared to DOA.
Disclosure: Nothing to disclose.
P479 | REM sleep without atonia in patients
with idiopathic REM sleep behavior disorder and
Parkinson disease patients with and without
REM sleep behavior disorder
P. Perinova; P. Dusek; J. Nepozitek; S. Dostalova; I.
Dall´antonia; K. Sonka
Sleep and Wake Disorders Center, Department of Neurology and Center
for Clinical Neuroscience, First Faculty of Medicine, Charles University
and General University Hospital, Prague, Czech Republic
Objectives/Introduction: Rapid eye movement sleep behavior dis-
order (RBD) may be present in the setting of a clinically manifest
synuleinopathy such as Parkinson disease (PD), Lewy body dementia
or multiple system atrophy, or is considered to be idiopathic (iRBD)
in absence of any of these conditions. There is a limited number of
studies comparing disruption of atonia during REM sleep (RWA) in
iRBD and PD patients with RBD (PD-­RBD+).
Methods: We assessed 31 iRBD (mean age 63.2 ( ± SD 9.6) years),
13 newly diagnosed PD-­RBD+ (mean age 60.3 (± 10.8) years) and
21 PD without RBD (PD-­RBD-­) (mean age 52.5 ( ± 11.8) years) pa-
tients regarding a broad spectrum of clinical and polysomnographic
parameters. ICSD-­3 was used to diagnose RBD. Both AASM scoring
manual and SINBAR criteria were used to assess the presence and
characteristics of EMG activity during REM sleep. Only patients with
AHI < 15 and PLMI < 30 were included.
Results: iRBD patients scored higher in RBD-­SQ (9.5) than PD-­RBD+
patients (5.5), p = 0.00002. Assessed according to the AASM rules,
ABSTRACTS
the mean RWA ratio was 53.3% in iRBD group and 34.7 % in PD-­
RBD+ group (p = 0.032), while SINBAR index was 49.3% and 34.8%
in iRBD and PD-­RBD+ group (p = 0.046), respectively. There was no
difference among the proportion of tonic, phasic nor mixed EMG ac-
tivity comparing iRBD with PD RBD+ and PD-­RBD+ with PD-­RBD-­
groups. All the other PSG parameters did not display any significant
difference either.
Conclusions: iRBD patients exhibit higher rate of RWA than PD-­
RBD+ patients and score higher in RBD-­SQ. These results might
indicate that iRBD preceding manifest neurodegeneration by many
years may constitute a specific phenotype of synucleinopathy or
that RWA and even the dream enactment behavior could tend to de-
crease over the course of ongoing neurodegeneration. Due to pos-
sible selection bias in our study -­iRBD subjects searched for medical
care because of behavioral symptoms of RBD while PD subjects
were screened regardless of RBD complaint -­longitudinal examina-
tion is necessary to confirm one of these explanations.
Disclosure: Nothing to disclose.
P480 | Impaired autonomic function in patients
with REM sleep behavior disorder as a marker of
progression?
W. Hermann1,2,3; L. Ecke3; D. Wittig4,5; L. Schütz1; D.
Hausbrand3; M.D. Brandt3,6; H. Reichmann3; A. Storch1,2; T.
Ziemssen3
1 P481 | Interrelationships between sleepiness
Department of Neurology, University of Rostock; 2Department of
Neurology, German Center for Neurodegenerative Diseases (DZNE)
Rostock, Rostock; 3Department of Neurology; 4
Department of
Ophthalmology, Technische Universität Dresden; 5German Center
6
for Neurodegenerative Diseases (DZNE) Dresden; Department of
Neurology, German Center for Neurodegenerative Diseases (DZNE)
Dresden, Dresden, Germany
Objectives/Introduction: Clinically isolated REM Sleep Behavior
disorder (iRBD) is a parasomnia, which is now recognized as the pro-
dromal phase of neurodegenerative disorders such as Parkinson's
disease (PD). However, prediction of progression rate and time to
phenoconversion from iRBD to are yet to determined by biomarkers.
Autonomic symptoms are well-­known non-­motor symptoms (NMS),
particularly in Multiple System Atrophy (MSA) and PD. Nevertheless,
autonomic disturbances already occur in iRBD affecting up to 94% of
patients. Several studies have demonstrated autonomic dysfunction
comprising altered heart rate variability, autonomic reflex testing
and sudomotor function in iRBD in cross-­sectional studies, whereas
longitudinal evaluations are limited. Ocular coherence tomography
showed inconsistent results in PD, while in iRBD only limited evi-
dence is available yet.
Objective: Thus, this study was designed to evaluate auto-
nomic functions in iRBD compared to PD and controls including
|
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longitudinal follow-­up assessments to evaluate their potential to
serve as biomarkers.
Methods: We included 26 iRBD patients (age 71 ± 7, range 57-­83; f
8: 18 m) and matched PD patients (n = 29, age 68 ± 10, range 47-­83;
f 14: 17 m, UPDRS total 31.9 ± 12.8, H&Y 2.2 ± 0.8) as well as 38
controls (age 67 ± 9; range 46–78; f18: m20) at baseline. Detailed
evaluations were performed including questionnaires on autonomic
and sleep symptoms and objective measurements using Ocular co-
herence tomography (SD-­OCT), Pupillary light reflex testing and gal-
vanic skin response (SudoScan) at baseline and at follow-­up 2 years
later in the iRBD cohort (n = 16).
Results: Subjective autonomic burden was significantly elevated in
patients with iRBD and PD (p < 0.001) compared to controls (NMS,
both P < 0.001, Mann-­Whitney-­test). Pupillary light reflex findings
showed significant differences between iRBD and PD compared to
controls. Galvanic skin conductance was impaired in PD compared
to controls (p = 0.020), whereas no differences and no progress was
detected in the iRBD cohort. OCT RNFL measures did not differ sig-
nificantly between groups at baseline, but mean RNFL significantly
decreased over time in the iRBD cohort (p = 0.011).
Conclusions: Autonomic measures showed differences between
iRBD and PD patients compared to controls with progress in some of
the measures over time in iRBD patients. Further research is needed
to evaluate these potential biomarkers markers in iRBD.
Disclosure: Nothing to disclose.
and the other obstructive sleep apnea symptoms
K. Baou; M. Vagiakis; A. Minaritzoglou; M. Andritsou; E.
Vagiakis
Critical Care and Pulmonary Services, Sleep Disorders Center,
University of Athens Medical School, Evangelismos Hospital, Athens,
Greece
Objectives/Introduction: Excessive daytime sleepiness (EDS) is a
cardinal symptom of obstructive sleep apnea (OSA). OSA patients
who experience EDS have greater risk of poor quality of life and
motor vehicle crashes. As the presence of EDS is of great impor-
tance in OSA patients, the aim of this study was to investigate the
relationship between the subjective sleepiness, and other frequent
symptoms of OSA.
Methods: A retrospective review of the clinical symptoms of 280
consecutive OSA patients who were diagnosed in our lab, between
January 2017 to December 2017, was performed. The diagnosis
of OSA was established when the Apnea-­
Hypopnea Index(AHI)
was  ≥  5 event/hour on the attended overnight polysomnography.
Sleepiness was assessed by the Epworth Sleepiness Scale (ESS) (ESS
scores > 10).
Results: The study population consisted of 280 patients, mean age
54.5 ± 12.5 years, 71% were males, with median AHI 33.5 (16–60)
 |
302 of 356       ABSTRACTS
events/hour and median ESS 9 (6–13). From those, 116 (41%) pa-
tients had ESS score > 10. Daytime symptoms: Compared to non-­
sleepy OSA patients, sleepy patients had increased percentage of
attention difficulties 23% vs 12% (p < 0.01) and concentrating dif-
ficulties 25% vs 13% (p < 0.05), increased feeling of tiredness 78%
vs 52% (p  <  0.001), and depression 6% vs 1% (p  <  0.05), morning
headaches 34% vs 22% (p < 0.05), and dry mouth upon awakening
71% vs 60% (suggestive p = 0.06). Overnight symptoms: Sleepy OSA
patients presented with increased percentage of awakenings with
gasping 47% vs 33% (p < 0.05), restless sleep 64% vs 41% (p < 0.001),
nocturnal jerks 43% vs 30% (p < 0.05), compared to non-­sleepy pa-
tients. Other symptoms such as, nocturia nocturnal sweats, insom-
nia, nightmares, aggressiveness did not have any difference between
the two groups. There was a positive correlation between ESS and
the number of times of awake to urinate (rho = 0.110, p = 0.05), after
adjustment for confounding factors (diuretic drugs, gender, age), this
correlation remained (R 2 = 0.014, p = 0.05).
Conclusions: Sleepiness has a great impact on sleep quality and
overall quality of life in OSA patients and should be in great atten-
tion. Sleepy patients with OSA suffer and complain more frequently
and from other daytime or overnight symptoms.
Disclosure: Nothing to disclose.
P482 | Evaluation of APAP parameters in
one to three nights titration for final pressure
decision-­making in a real world clinical setting
J. Escribá Alepuz1,2,3; L. Herrero Huertas4; A. Saura
Vinuesa5; M. Palop Cervera5; A. Lloris Bayo5; J. Segrelles
Pérez6; O. Cercas Erquiaga6; G. Ramos Marco6; F.J. Puertas
Cuesta7,8
1
Neurophysiology Department, Sagunto University Hospital (Valencia),
Sagunto; 2Instituto de Medicina del Sueño; 3UCH-­CEU University,
Valencia; 4CIBERESP, Centro Nacional de Epidemiologia, Madrid;
5
Pneumology Department, Sagunto University Hospital (Valencia),
Sagunto; 6AirLiquide Healthcare Spain, Valencia; 7Sleep Unit-­
Neurophysiology Department, La Ribera University Hospital, Alzira;
8
Univesidad Católica de Valencia (UCV), Valencia, Spain
Objectives/Introduction: AutoCPAP (APAP) is becoming the stand-
ard definitive sleep apnea (OSA) treatment. The aim of this study
was to compare pressure values obtained from APAP titration with
the final pressure (Pf) selected by the clinician after a complete
follow-­up.
Methods: We performed a retrospective descriptive study in 114
consecutive OSA patients diagnosed by home-­sleep testing (HST),
and treated with CPAP attended in the Pneumology Unit in Sagunto
University Hospital, Valencia (Spain). After a 3 months adaptation
period with empiric CPAP pressure, patients underwent 2–3 nights
with 2 different APAP devices. We obtained pressure values in terms
of percentile 95 (P95) and median (Pm) from every night. Device
1 was used 4 times during 2 nights and 26 times during 3 nights.
Device 2 was used 12 times during 2 nights and 18 times during
3 nights. Then clinicians decided a pressure (Pa) taking in account
APAP values and visual analysis, until the 3 months follow-­up con-
sultation when, according to clinical outcomes, a new assessment
established the Pf.
We selected 60 patients (30 for each device) meeting the inclusion
criteria: minimum of 2 valid APAP nights with no compliance prob-
lems and without significant leaks, stable optimal Pf (1 year without
changes or health care needed) and use of CPAP > 4 hours/day for at
least 3 consecutive months. Data analysis was blind and random, by
an experienced and independent sleep physician and how and why
the clinicians used the APAP was statistically evaluated, measuring
automatic pressure values from each device for every patient and
combination of nights, comparing those parameters with Pf, whose
correlation with AHI was also analyzed.
Results: In order to predict Pf, we found significant evidence (p <
0.05) using Pm and device 2 in comparison with P95 and device 1,
respectively. Besides, there are no statistical difference (p > 0.05)
performing more than one APAP night but AHI shows statistical sig-
nificance (p < 0.05) as a compliance predictive value.
Conclusions: Our results suggest that clinicians mostly prescribed
a 3-­nights APAP study and consider its values in their decision-­
making. Just one APAP night, Pm and device 2 are good APAP titra-
tion strategies.
Disclosure: Nothing to disclose.
P483 | Obstructive sleep apnea syndrome -­
diagnostic clues and hospital referral
M. Baptista1; M. van Zeller2; A. Marinho2; M. Redondo2; M.
Sucena2; M. Drummond2
1
Pulmonology, University Hospital Cova da Beira, Covilhã; 2University
Hospital São João, Porto, Portugal
Objectives/Introduction: Obstructive Sleep Apnea Syndrome
(OSAS) is a common disorder that affects quality of life, representing
a frequent motive of hospital referral. It is both a risk factor and a
comorbidity of cardiovascular diseases.
Methods: Prospective study of patients referred to Sleep Disordered
Breathing (SDB) consultation with suspected OSAS in the first se-
mester of 2019. Statistical analysis performed by SPSS v 2.5, p value
0.005.
Results: Analysis of 380 patients, mean age 57 ( ± 13) years and male
predominance (64.5%). Polysomnography (level 3) confirmed OSAS
in 326 patients (85.8%). 60.4% had moderate to severe OSAS and
53.4% started treatment with positive pressure, mainly CPAP.
OSAS patients were older and had higher body mass index (p <
0.005). Many individuals had hypertension (63.5%), obesity (60.4%)
and dyslipidemia (47.2%), and there was a significant association be-
tween these comorbidities and OSAS (χ 2 p < 0.005).
ABSTRACTS
Snoring was the most reported symptom (67.5%), but only 31.7%
had excessive daytime sleepiness in Epworth Sleepiness Scale. None
of these symptoms were significantly associated with presence of
OSAS.
Referral was made mostly by Family Medicine (31.3%), Otorhi­
nolaryngology (16.3%) and Internal Medicine (10.7 %), with confir-
mation of clinical suspicion above 87%.
Conclusions: The high percentage of OSAS, its severity and need of
treatment suggests an appropriate referral to SDB consultation by
most specialties.
Obese patients with cardiovascular comorbidities should be a target
population for OSAS screening, but symptoms may not reflect the
severity of the problem.
Referral to SDB consultation should follow defined criteria and, if
possible, use validated tools of screening and risk stratification.
Disclosure: Nothing to disclose.
P484 | Diagnosis and treatment of obstructive
sleep apnea syndrome in patients with heart
failure
M. Baptista1; M. van Zeller2; A. Marinho2; M. Sucena2; M.
Redondo2; M. Drummond2
1
University Hospital Cova da Beira, Covilhã; 2University Hospital São
João, Porto, Portugal
Objectives/Introduction: Obstructive sleep apnea syndrome (OSAS)
and heart failure (HF) seems to have a bidirectional relationship with
prognostic impact and both are affected cardiovascular risk factors.
Methods: Prospective study of patients referred to Sleep Disordered
Breathing (SDB) consultation with suspected OSAS and HF.
Results: 380 SDB consultations were carried out, with confirmation
of OSAS in 326 patients. The prevalence of HF in these patients was
16.6% (n = 54). Patients with OSAS and HF were mostly male (74.1%)
and had a greater mean age than patients without HF (69 ± 12 vs 56
± 12; p = 0.000). All patients with OSAS and HF had other cardiovas-
cular risk factors, such as arterial hypertension (83.3%), dyslipidemia
(72.2%) and obesity (64.8%). There was a statistically significant
association between the presence of more comorbidities and HF
2
(χ = 62.4; p = 0.000). Concerning HF etiology, ischemic heart dis-
ease ranked first (38.9%), followed by hypertensive heart disease
(24.1%) and multifactorial HF (18.5%). Most cases had preserved
ejection fraction (70.6%), with no association between the ejection
fraction and the severity of OSAS. Epworth Sleepiness Scale (ESS)
mean score was lower in patients with HF (6.9 ± 4.4 vs 8.6 ± 5.5;
p = 0.037). These patients also had less snoring (64.4% vs 68.1%)
and more frequent complaints of nocturia (45.8% vs 36.8%), but the
difference was not statistically significant. The proportion of cases
of mild and severe OSAS in patients with HF was identical (38.9%
each), but with slightly higher mean Apnea/Hypopnea index (29.2 ±
22.1/h). 67.8% of patients with HF started treatment with positive
|
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pressure, a higher percentage than those without HF (χ 2 = 12.96; p =
0.000). There was no difference in the choice of continuous positive
pressure (CPAP) or bi-­level.
Conclusions: In this study, patients with OSAS and concomitant HF
were older and had more comorbidities, which increases the com-
plexity of their approach. Although the presence of HF did not reveal
an impact on the severity of OSAS, it was associated with a greater
proportion of patients in need of treatment. Patients with HF had
less daytime sleepiness when evaluated by ESS, allowing to question
the role of this questionnaire in these cases.
Disclosure: Nothing to disclose.
P485 | Anthropometric measures: helping risk
stratification for obstructive sleep apnea
J. Costa1; M. Oliveira1; F. Ramalho Fernandes1,2; J.M. Silva1,2;
C. Rito2; A. Tavares1,2
1
Pulmonology Department; 2Sleep Disorder Clinic, Unidade Local de
Saúde da Guarda, E.P.E., Guarda, Portugal
Objectives/Introduction: Obstructive Sleep Apnea (OSA) is ex-
plained by collapse and obstruction of the upper airway during sleep,
triggering repeated episodes of hypopnea and apnea. Previous stud-
ies demonstrated that large neck circumference (NC) is a risk factor
for severe OSA along with body mass index (BMI) and an important
OSA predictor. Neck circumference-­height ratio (NHR) has also been
reported as an effective tool to predict OSA severity. We aimed to
evaluate the relationship between BMI, NC, NHR and OSA severity
and investigate whether these measurements might be helpful pre-
dictors for the diagnosis of OSA and presence of severe OSA.
Methods: A total of 101 patients referred to our clinic during 2019
underwent home respiratory polygraphy. We collected and further
analyzed their anthropometric and polysomnographic data using
IBM SPSS Statistics® v24 with Spearman's correlation test, logis-
tic regression analysis and receiver-­operating characteristic (ROC)
curve.
Results: The mean patient age was 56.5 ± 10.9 years. From the
whole sample, 83 patients were diagnosed with OSA (37.8% mild,
28% moderate, 34.1% severe). Correlation was found between AHI
and BMI (r = 0.371, p < 0.01), NC (r = 0.532, p < 0.01) and NHR (r
= 0.503, p < 0.01). Although BMI, NC and NHR were significantly
higher in OSA patients, these anthropometric measures were not
recognized as independent risk factors for OSA. When limited to
patients with OSA, NC presented as an independent variable for
distinguishing the presence of mild to moderate versus severe OSA
(p < 0.05). Area under curve derived from the ROC curve = 0.788.
Optimal cut-­off for NC was set at 40.5 cm, with sensitivity = 75%,
specificity = 68.5%, positive predictive value = 55.3% and negative
predictive value = 84.1%, meaning that patients presenting NC lower
than the cut-­off will likely correspond to mild or moderate OSA.
 |
304 of 356       ABSTRACTS
Positive likelihood ratio indicates that a patient with NC > 40.5 is
2.38 more likely to have severe OSA.
Conclusions: Although BMI and NHR correlated with AHI and were
higher in OSA patients, none of them seemed to play a major role
predicting OSA and its severity. On the other hand, NC -­a marker of
central obesity and easily obtainable measure -­proved to be useful
predicting OSA presence and distinguishing more severe forms.
Disclosure: Nothing to disclose.
P486 | Psychopathological comorbidity of adult
sleepwalking
S. Delis Gómez; R. Wix Ramos; E. Rocío Martín; L. López
Viñas
Hospital Universitario La Princesa, Madrid, Spain
Objectives/Introduction: Sleepwalking (SW) often has been linked
with psychopathology/psychiatric disorders, but the nature and
degree of this relation remains uncertain. The purpose of this clini-
cal series of 31 patients with sleepwalking is to assess the possible
clinical association between this sleep disorder and the presence
of psychopathology and psychiatric antecedents in a cohort of
sleepwalkers.
Methods: Retrospective descriptive study, based on the review of
the medical records of 31 cases evaluated in our Sleep Department
from 2014 to 2020, with a diagnosis of sleepwalking according to
ICSD3 criteria. We evaluate demographic data, past medical history
and scores on sleep/psychological tests [Insomnia Severity Index
(ISI) psychological tests; Beck depression inventory (BDI-­II) {no-­mild
≤19, moderate-­severe (20–63)}; the state-­trait anxiety inventory
(STAI) considered positive above 50th percentile]. Statistical analysis
included paired sample test in the SigmaPlot program.
Results: In our series of 31 patients, 18 were female (58%) and 13
were male (42%), they ranged from 18 to 57 years, with a median
of 29.6 years (SD: 8.48). 16% (5) of our patients had previous an-
tecedents of psychiatric disorder (4 with mixed anxiety-­depressive
disorder and 1 with schizophrenia). 11 patients (35%) had high fre-
quency of episodes (diary/weekly), and 20 (65%) a lower frequency
(monthly/biannual/annual). Regarding the tests, 13% (7 patients) had
moderate or severe depression, 39% (12 patients) anxiety trait, 39%
(12 patients) anxiety state, 35% (11 patients) had moderate or se-
vere clinical insomnia. We didn't observe greater tendency to anxi-
ety state-­trait (p = 0.82, p = 0.65, respectively), neither depression
(p = 0.26), comparing the groups with a high frequency versus low
frequency of episodes.
Conclusions: The majority of adult sleepwalkers consulting for the
disorder do not report past medical history for psychiatric disorders,
they show clinically relevant levels of depression or anxiety com-
pared with the general population, but no significant difference re-
garding the frequency of episodes.
Disclosure: Nothing to disclose.
P487 | Trauma-­associated sleep disorder -­a
distinct sleep disorder?
S. Williams
Sleep Medicine Research Unit, University of Edinburgh, Edinburgh, UK
Objectives/Introduction: To test the hypothesis that REM Sleep
Behaviour Disorder (RBD) and Trauma associated Sleep Disorder
(TSD) are distinct sleep disorders that exist in the general population.
Methods: A retrospective cohort study of 122 consecutive RBD pa-
tients (103 male) who visited the Royal Infirmary Hospital Edinburgh
(RIE) and a Czech Hospital between May 2005 and February 2020
was undertaken in March 2020. Patients who were diagnosed as hav-
ing idiopathic RBD (iRBD) by video Polysomnography and who under-
went a semi-­structured interview at presentation which documented
clinical characteristics, sleep habits, dream content and history of
trauma. Patients with secondary RBD (having neurodegenerative
syndromes that manifested prior to RBD symptom development or
patients on antidepressant therapy) were excluded (n = 38).
Patients were categorised into three groups according to reported
trauma history: 1) No history of trauma, 2) traumatic experience
prior to 12 months of RBD symptom onset, 3) traumatic experience
within 12 months of RBD symptom onset. RBD duration was defined
as the interval between estimated onset of RBD symptoms and last
visit at the RIE or death. Follow-­up duration was defined as the inter-
val between RBD diagnosis and last visit at the RIE or death.
Results: In a follow up period of up to 15 years, no patients who
experienced trauma within 12 months preceding their iRBD diag-
nosis (Group 3) received a diagnosis of a neurodegenerative dis-
order (n = 35), whereas 33% of patients who had not experienced
trauma within 12 months of diagnosis (Groups 1 & 2) subsequently
developed an alpha-­synuclein pathology. Patients who had not ex-
perienced trauma or had experienced historical trauma (Groups
1&2) were significantly more likely to have a family history of alpha-­
synucleinopathy compared to Group 3. No significant difference
was found in the other distinguishing features of RBD and TSD.
Conclusions: As a statistically significant result was found when
examining the neurodegenerative disease-­free survival rate of pa-
tients who had experienced trauma within 12 months of RBD onset
as compared to patients who had not, studies are required to further
demarcate TSD as a distinct sleep disorder.
Disclosure: Nothing to disclose.
ABSTRACTS
P488 | REM sleep behavior disorder in patients
with idiopathic hyposmia
P. Marrero; M. Serradell; J. Santamaria; C. Gaig; D. Bedoya; J.
Mullol; I. Alobid; I. Vilaseca; A. Iranzo
Hospital Clinic de Barcelona, Barcelona, Spain
Objectives/Introduction: Idiopathic hyposmia (IH) is a marker of
the prodromal phase of Parkinson disease (PD). While IH is com-
mon in the general population, PD only develops in a small minority.
Conversely, REM sleep behavior disorder (RBD)is the most specific
prodromal marker of PD since the majority of patients develop PD or
a related synucleinopathy with time.
The objectives of our study are:
• To determinate the frequency of RBD in patients diagnosed with
IH.
• To evaluate the development to PD.
Methods: We conducted a prospective study of 25 consecutive pa-
tients older than 50 years who were self-­referred for smell loss and
were diagnosed with IH. IH was defined as chronic complain of smell
loss of unknown etiology and without neurological diseases linked.
The Barcelona Smell Test-­24 was applied to objectify IH. A nocturnal
video-­polysomnography (V-­PSG) was performed and quantification
of electromyographic activity in REM sleep was evaluated in the
mentalis and in the right and left flexor digitorum superficialis. After
follow-­up of 4.7 ± 2.2 (range, 0.5–7.7) years, participants were re-­
assessed for signs of PD.
Results: Three (12%) patients were diagnosed with polysomnogra-
phy proven RBD, with excessive EMG activity during REM sleep of
39%, 49% and 56% respectively. At the end of follow-­up, one (4%)
patient with IH who had RBD developed PD while the rest of the
patients remained disease-­free.
Conclusions: Most of the patients with IH do not have RBD, but its
prevalence (12%) is higher than in the general population (0.5–1%)
and constitutes a risk factor for developing PD.
Disclosure: Nothing to disclose.
P489 | Morbidity in patients with NREM
parasomnias in the Danish population
N. Suhak1; P. Jennum1,2
1
Danish Center for Sleep Medicine, Department of Clinical
2
Neurophysiology, Rigshospitalet; Faculty of Health Sciences,
University of Copenhagen, Copenhagen, Denmark
Objectives/Introduction: Non rapid eye movement (NREM) paras-
omnias represent abnormal arousal reactions and can be associated
with other diseases. In rare cases they also can be secondary to
some medical conditions or medications. We evaluated the morbid-
ity rate in 21 WHO disease classification groups in a national cohort
|
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of patients 3 years before and after 3 years after the diagnoses of
NREM parasomnia was made.
Methods: All patients in Denmark with a diagnosis of NREM par-
asomnia between 2006–2016 were identified from the Danish
National Patient Registry records. There were 1.505 patients in age
from 0 to over 80 years. 901 patients were included with morbidity
data 3 years prior to and after diagnoses. Comparative analysis was
performed using 3601 randomly chosen controls matched for age,
gender, geography and marital status. Comorbidities were calculated
three years before and after diagnoses.
Results: NREM parasomnia patients have the significantly higher co-
morbidity rate (p < 0.05) in 18 from 21 WHO disease classification
groups 3 years before and in 17 from 19 (lack of the data for 2 groups)
WHO disease classification groups 3 year after the diagnosis was made
compared to controls. Among others, morbidity in NREM parasomnia
patients was especially high both before and after diagnosis in the some
diseases groups e.g. diseases of the nervous system (respectively 31.5%
(Odds Ratio 95% CI 11.0; 8.7–14.0) and 90.6% (171.9; 106.2–278.3)),
circulatory system (18.8% (1.9; 1.6–2.3) and 23.3% (2.0; 1.7–2.5)), and
in the group of injury, poisoning and certain other consequences of ex-
ternal causes (39.8% (1.9; 1.6–2.3) and 36.2% (1.8; 1.5–2.1)).
Conclusions: We have shown, that a diagnosis of NREM parasomnia
was associated with increased morbidity in the most of WHO disease
classification groups in Danish cohort of patients both before and
after the diagnosis was made. Association of arousal disorders with
mental and behavioral diseases and with some neurological condi-
tions are well known. But the results of the study rise an awareness
than burden of the undiagnosed or untreated NREM parasomnias
can be bigger than previously thought especially taken in account
significant association with injury, poisoning and certain other con-
sequences of external causes.
Disclosure: Nothing to disclose.
P490 | Respiratory effort assessment across
clinical clusters in pediatric sleep disordered
breathing
J. Martinot1,2; N. Le-Dong3; V. Cuthbert1; D. Gozal4; J.
Pépin5
1
Sleep Laboratory, CHU Université Catholique de Louvain (UCL)
Namur Site Sainte-­Elisabeth, Namur; 2Institute of Experimental and
Clinical Research, UCL Bruxelles Woluwe, Brussels; 3Sunrise, Namur,
Belgium; 4Child Health Research Institute, University of Missouri,
Columbia, MO, USA; 5Pôle Thorax et Vaisseaux, Centre Hospitalier
Universitaire (CHU) de Grenoble-­A lpes (CHUGA), Université Grenoble
Alpes, Institut National de la Santé et de la Recherche Medicale,
Grenoble, France
Objectives/Introduction: In children, sleep disordered breathing
(SDB) manifests as a spectrum of complex and heterogeneous pat-
terns of clinical symptoms which cannot be reliably captured by the
 |
306 of 356       ABSTRACTS
PSG-­derived AHI alone. We have previously shown that the cumula-
tive duration of respiratory efforts (Sr_RE) during sleep and derived
from the automated analysis of mandibular movements (MM) by a
wireless sensor (Sunrise, Namur, Belgium) provides a relevant and
useful metric for the diagnosis of SDB in adults. In the present study,
we evaluated the clinical utility of Sr_RE in pediatric SDB. We also
explored potential associations between Sr_RE and sleep respira-
tory effort (SRE) -­related symptoms, as well as the ability of Sr_RE to
identify different SDB clinical subtypes in children.
Methods: The study was conducted on a clinical cohort of 140 chil-
dren referred for PSG evaluation for suspected SDB. First, we ap-
plied the k-­prototype algorithm to classify the patients into latent
clinical subtypes, then evaluated the association between Sr_RE and
the specific symptoms in these clusters. A similar approach was per-
formed for PSG indices (RDI, AHI) as well.
Results: Using only self-­reported symptoms, 3 latent clinical sub-
types were identified. Classification into these subtypes was sig-
nificantly associated with a higher prevalence of snoring (p = 0.001),
daytime sleepiness (p < 0.001), witnessed apnea (p = 0.02), breathing
efforts (p = 0.04) and night sweating (0.03). Despite the fact that the
clusters were generated without using any PSG or Sr_RE measures,
significant differences emerged among subtypes for both PSG_RDI
(p = 0.03) and Sr_RE (p = 0.01).
Logistic regression and Bayesian network analyses indicated that
within each subtype, the Sr_RE index was associated with more
SDB symptoms (9 links), compared to PSG_AHI and RDI (only 6 to
7 links). The association strength was also higher between Sr_RE
and SRE-­related symptoms, including observed breathing efforts
(OR = 12.17), snoring (OR = 3.63), witnessed apnea (OR = 2.28) and
non-­restorative sleep (OR = 11.99), in comparison with associations
based on PSG (all OR values less than 2).
Conclusions: Our findings suggest that MM-­derived indices, particu-
larly the cumulative duration of sleep respiratory efforts provide in-
creased clinical relevance than the PSG_AHI or PSG_RDI to indicate
the presence of the SDB-­related symptoms in children.
Disclosure: Dr Martinot reported being a nonremunerated scientific
advisor to Sunrise. Dr Le-­Dong reported receiving personal fees
from Sunrise. No other disclosures were reported.
P491 | Sleep disorders in night workers: effect
of the shiftwork rotation scheme
R. Lecca1; G. Melis Acar2; M. Figorilli1; P. Congiu1; G. Gioi1;
R. Loscerbo2; F. Meloni2; P. Cocco2; M. Puligheddu1
1
Interdepartmental Sleep Research Centre; 2Department of Medical
Sciences and Public Health, Unit of Occupational Medicine, University
of Cagliari, Cagliari, Italy
Objectives/Introduction: Shift work adversely affects sleep causing
sleep deprivation, insomnia, and daytime sleepiness. Shift rotation
schemes can influence workers’ tolerance of nightshift work.
Aim of this study is to assess whether a regular or irregular shift rota-
tion scheme differentially affects day time sleepiness and sleep quality
among nightshift workers, and to identify factors influencing adaptation.
Methods: We recruited for study 145 male workers, including 77
from a ceramic tile factory (group1) and 68 from a dockyard com-
pany (group2). Factory workers had a fixed forward rotation shift-­
work scheme: two morning (M) shifts, two evening (E), two night
shifts (N) and three rest days (R) (MMEENNRRR). Dockyard workers
had an irregular schedule, due to their job depending on several ex-
ternal factors. We administered to both study groups the Epworth
Sleepiness Scale (ESS) and the Pittsburgh Sleep Quality Index (PSQI)
questionnaires. We also gathered self reported data on demographic
and lifestyle variables.
We used non parametric methods to compare median value and in-
terquartile range (IQ) of ESS and PSQI scores by smoking, alcohol,
marital status, and engagement in nightshift work, as well as their
correlation with age and BMI. We studied the probability of occur-
rence of somnolence (ESS score ≥ 12) and poor sleep (PSQI score ≥
5) with logistic regression analysis.
Results: The study groups were homogeneous for age, marital status
and BMI. 94% dockyard workers worked on average 8.5 (sd 3.65) night-
shifts/month; 69% ceramic tile worked 4.3 (sd 2.9) nightshifts/month.
Quality of sleep and day time sleepiness did not differ between the two
groups (ESS: p = 0.425; PSQI: p = 0.795). ESS score was inversely related
to age, and ESS scores ≥10 were more frequent among dockyard work-
ers (p = 0.04). Other variables, such as marital status, BMI, smoke, and
alcohol intake, did not significantly affect ESS and PSQI score.
Conclusions: Our results suggest that irregular shift rotation sched-
ules increase risk of excessive daytime somnolence in respect to a
regular rotating scheme, suggesting that adaptation is more difficult
and risk for reduced cognitive performance higher in association
with this specific working schedule.
Disclosure: Nothing to disclose.
P492 | Clinical data in groups with elderly
obstructive sleep apnea hypopnea syndrome and
cognitive impairment
A. Buigues Lafuente1; A. García Verdú1; I. Toledo Samper1;
J.B. Aller Álvarez1; M. Baquero2; I. Ferrer3; P. Rubio
Sánchez1; E. Gómez Siurana1
1
Clinical Neurophysiology; 2Neurology; 3Clinical Psychology, Hospital
Universitario y Politécnico La Fe, Valencia, Spain
Objectives/Introduction: The apnea-­hypopnea index (AHI) is defined
as the summary of apneas and hypopneas per hour of sleep and is as-
sociated with several clinical manifestations. The aim of the study is to
analyze these clinical manifestations associated with the AHI.
Methods: A cross-­sectional-­prospective study has been made in
patients of Cognitive Impairment and Sleep Units of our center be-
tween February 2014 and December 2018.
ABSTRACTS
Three groups of study have been included following The National
Institute on Aging and Alzheimer's Disease Association (NIA-­A A) cri-
teria: mild cognitive impairment group without Alzheimer Disease
(MCI) -­27 patients-­, MCI with Alzheimer Disease group (AD) -­23
patients-­, control group (C) -­15 patients.
An obstructive apnea-­hypopnea syndrome (OSAHS) clinical profile
with Epworth Sleepiness Scale (ESS) and a polysomnography (PSG),
following AASM 2012 criteria, have been conducted. The statisti-
cal analysis was done using T-­Student and Pearson Chi squared test
with Yates correction. Furthermore, clinical history sensitivity has
been analyzed.
Results: A total sample of 65 subjects, distributed in 3 groups,
showed statistically significant differences in:
• AHI averages between AD-C (p-value: 0.037). AHI was 18.15
(17.92) on C; 24.7 (16.59) on MCI and 32.30 (20.98) on AD.
• Presence of dyslipidemia between AD-C (p-value: 0.0001) and
MCI-C (p-value: 0.0001).
• ESS averages between AD-MCI (p-value: 0.001) and AD-C (p-
value: 0.0001).
In addition, sensitivity of the OSAHS clinical history against PSG has
been analyzed, considering that sensitivity of PSG, as a gold stand-
ard test in this disease, is 100%. The sensitivity of clinical history for
C was 63.3%, in MCI was 43% and in AD was 14.2%. As it may be
seen, sensitivity of clinical history was poor, especially in AD.
No statistically significant differences have been found on gender,
body mass index, hypertension neither diabetes.
Conclusions: Clinical history of OSAHS in elderly patients has lower
sensitivity than PSG. We can consider PSG as one of the main tests
in Cognitive Impairment Units, because these patients might have
high probabilities of OSAHS.
We have also found that AHI grows according to the cognitive im-
pairment, being the AHI bigger in AD than in C. However, ESS de-
creases according to the cognitive impairment.
Disclosure: Nothing to disclose.
P493 | REM sleep behavior disorder and
other sleep disturbances in Alzheimer's disease,
dementia with Lewy bodies and in dementia
cases of uncertain classification
I. Pieroni1,2,3; G. Cerroni2,3; L. Velluto2,3; S. Ferrara3,4; A.
Bartoli3,4; A. Serio3,4; S. Sorbi1,3,5; B. Guarnieri2,3
1
Department of Neuroscience, Psychology, Pharmacology and Child
Health, University of Florence, Florence; 2Center of Sleep Medicine,
Villa Serena Hospital; 3Fondazione Villaserena per la Ricerca;
4
Department of Neurology, Villa Serena Hospital, Pescara; 5IRCCS Don
Gnocchi, Florence, Italy
Objectives/Introduction: Sleep disorders are common in persons
with Alzheimer´s disease (AD) and dementia with Lewy bodies
|
      307 of 356
(DLB). Their identification, especially of REM sleep behavior disor-
der (RBD), a core clinical feature for DLB diagnosis, is an important
support to improve diagnostic accuracy between these two types of
dementia and optimize therapeutic strategies.
Methods: In this ongoing study, consecutive patients with AD, DLB
or uncertain diagnosis between AD/DLB and mild-­to-­moderate de-
mentia severity are screened for sleep disturbances. Recruited pa-
tients undergo two consecutive full-­night video-­polysomnographies
(vPSG). Patients diagnosed with moderate to severe obstructive
sleep apnea (OSA) after the first vPSG are treated with positive air-
way pressure (PAP) ventilation during the second vPSG.
Results: To date, 31 patients have been screened and 13 recruited
(60% men; mean age 77 ± 2 years; 46% Clinical Dementia Rating
score [CDR] 1 and 54% CDR 2). At enrollment, 54% had a diagnosis
of AD, 23% of DLB and 23% of AD/DLB. 69% of patients complained
of poor sleep quality, while only 15% of excessive daytime sleepi-
ness. 77% presented a high risk for OSA, 70% a clinically possible
RBD and 38% restless legs syndrome. VPSG analysis confirmed OSA
in 9 patients, periodic limb movements in 7 and confusional arousals
in 4. 86% of OSA patients used PAP treatment for at least 5 hours
during the second vPSG. RBD was confirmed in 10 patients. Based
on these findings and according to current DLB diagnostic criteria,
5 patients previously diagnosed with AD and 2 patients AD/DLB
were diagnosed with DLB. Moreover, CDR 2 patients presented a
decrease in percentage of REM sleep and atypical REM sleep phases
(predominant delta activity) as compared to CDR 1 patients (p =
0.048 and p = 0.027, respectively).
Conclusions: Our preliminary findings show a high comorbidity of
vPSG-­confirmed RBD with other primary sleep disorders (OSA in par-
ticular) in dementia patients. Both in AD and DLB, with the progression
of cognitive decline, standard REM sleep scoring becomes complex.
VPSG remains the gold standard for the diagnosis of RBD and its mim-
ics and it is a useful tool for improving dementia diagnostic accuracy.
Disclosure: Nothing to disclose.
P494 | Diurnal skin temperature variations and
rest-­wake activity patterns after acute ischemic
stroke
E. Pajediene1; E. Paulekas1; K. Petrikonis1; C.L. Bassetti2; D.
Rastenyte1
1
Lithuanian University of Health Sciences, Kaunas, Lithuania;
2
University of Bern, Bern, Switzerland
Objectives/Introduction: Non-­apnoea sleep-­wake disorders may be
associated with an increased stroke risk and a worse outcome; how-
ever these disorders are underinvestigated in the light of stroke risk
and prevention.
Aim: To analyse associations between sleep-­wake rhythm related
metabolic biomarkers and neurological outcome after acute is-
chemic stroke.
 |
308 of 356       ABSTRACTS
Methods: Patients hospitalized in Neurology department within the
acute period of stroke (2–7 days after first stroke symptoms) were
investigated with specific questionnaires, polysomnography, actig-
raphy and thermochron for body temperature. The p value < 0.05
was considered statistically significant.
Results: Altogether 31 patient (19 males) with the age median [min
÷ max] of 67.5 [39 ÷ 82] and primary NIHSS score of 4 [1 ÷ 16] were
diagnosed with an acute ischemic medial cerebral artery (MCA)
(24, 77.4%) or vertebrobasilar stroke (7, 22.5%). Actigraphy analy-
sis revealed 7 (22.6%) cases with impaired diurnal rhythm, 5 (16.1%)
-­insomnia, 13 (41.9%) -­hypersomnia, 16 (51.6%) -­disturbed night-­
sleep consolidation. Average for bedtime was 21:25:12 [17:40:00 ÷
23:56:54], for get up time -­ 6:58:27 [2:06:47 ÷ 11:48:35], for total
sleep time -­ 7:34:58 [3:39:00 ÷ 11:16:52], for sleep efficiency -­ 79.6
[44.7 ÷ 91.79], number of awakenings during night sleep -­ 43 [26.4
÷ 113].
Based on thermochron data, average skin temperature variation cor-
responded to diurnal core body temperature variation typical for hu-
mans: average temperature median [min ÷ max] values at 7 pm was
34.8 [33.7 ÷ 35.75], 11 pm -­ 35.06 [34.1 ÷ 36], 3 am -­ 35 [34 ÷ 36],
7 am -­ 34.1 [33.3 ÷ 35.4], 12 am -­ 34.3 [33.8 ÷ 35.1]. Higher average
skin temperature at 7 pm was associated with longer sleep onset,
delayed get up time and worse sleep efficiency.
More severe strokes were significantly related to reduced total sleep
time, when higher disability was associated with more delayed sleep
onset and get up time, higher average skin temperature at 7 pm and
12 am.
Conclusions: Majority of our acute ischemic stroke patients had
sleep-­wake rhythm disturbances, highly fragmented and insufficient
night-­sleep and daytime hypersomnia. Average skin temperature
variation had typical diurnal features; however, evening and noon
temperature changes were associated with the delayed and insuf-
ficient sleep, and higher disability after stroke.
Disclosure: Nothing to disclose.
P495 | Sleep and episodic memory in alcohol
use disorder with and without Korsakoff
syndrome
A. Laniepce1; S. Segobin1; C. André1; F. Bertran1,2; N.
Lahbairi1; A. Maillard1; A. Mary1; L. Urso3; F. Vabret1,4; N.
Cabé1,4; A.-L. Pitel1; G. Rauchs1
1
Normandie Univ, UNICAEN, PSL Université, EPHE, INSERM, U
1077, CHU de Caen, GIP Cyceron, NIMH; 2Unité d'Exploration et de
Traitement des Troubles du Sommeil, Centre Hospitalier Universitaire
de Caen; 3Addiction Department, Centre Hospitalier de Roubaix;
4
Addiction Department, CHU de Caen, Caen, France
Objectives/Introduction: Korsakoff's syndrome (KS) is defined by
an irreversible amnesia induced by the combination of Alcohol Use
Disorder (AUD) and thiamine deficiency. Recently detoxified AUD
patients without KS also show episodic memory deficits, which have
been related to sleep disturbances according to one study. However,
sleep difficulties in KS patients are largely uncharacterized, espe-
cially compared to AUD patients, and the links with memory defi-
cits remain unclear. The aim of the present study is to characterize
sleep disturbances in KS patients compared to AUD patients, and
to specify the relationships with cognitive impairments and notably
memory performance.
Methods: 28 patients (21 AUD and 7 KS patients) and 15 healthy con-
trols (HC) underwent a neuropsychological assessment (processing
speed, short-­term memory, executive functions, and episodic mem-
ory) and a polysomnographic recording. Between-­groups compari-
sons were performed on cognitive variables and sleep parameters.
Then, correlations were conducted, in the entire group of patients,
between cognitive and sleep variables that were significantly more
altered in KS patients compared to AUD patients. All analyses were
controlled by age and the Apnea-­Hypopnea Index.
Results: Compared to HC, both AUD and KS patients had impaired
performance for all cognitive domains (all p-­values < 0.05), with dis-
proportionate episodic memory deficits in KS patients compared to
AUD patients (p = 0.003). A significant group effect was observed
for the percentage of REM sleep (p = 0.004), with KS patients pre-
senting less REM sleep than both AUD patients and HC (p = 0.005
and p = 0.02 respectively) who did not differ from each other (p =
0.71). There was no significant group effect for the other sleep pa-
rameters (%N1, %N2, %N3 sleep, wake after sleep onset, arousal
index and stage shifts index). In the entire group of patients (AUD
+ KS), we found that episodic memory performance positively cor-
related with the proportion of REM sleep (r = 0.41, p = 0.03).
Conclusions: A lower proportion of REM sleep, observed only in KS
patients, was related to episodic memory deficits in AUD and KS pa-
tients. Thiamine deficiency or altered thiamine metabolism may re-
sult in abnormalities in specific brain regions involved in both episodic
memory and cortical activation during REM sleep. Thus, altered REM
sleep may contribute to the cognitive physiopathology of KS.
Disclosure: Nothing to disclose.
P496 | Morbidity, mortality and conversion
to neurodegenerative disorders in patients with
RBD in the Danish population
C. Asah1; R. Frandsen1; R. Ibsen2; J. Kjellberg3; P. Jennum1
1
Danish Center for Sleep Medicine, Department of Clinical
Neurophysiology, Rigshospitalet, Glostrup; 2i2iminds, Aarhus; 3Danish
Institute for Health Services Research, Copenhagen, Denmark
Objectives/Introduction: The underlying pathophysiology of idi-
opathic REM sleep behavior disorder (iRBD) is not fully understood,
although the condition is currently recognized as an early-­
stage
alpha-­
synuclein disorder. We evaluated the morbidity, mortality
and rate of conversion to a neurodegenerative disorder in a national
group of patients.
ABSTRACTS
Methods: All patients in Denmark with a diagnosis of RBD be-
tween 2006-­2013 were identified from the Danish National Patient
Registry records. We excluded patients who had received a diagno-
sis of narcolepsy or any of the following neurodegenerative diseases
before their diagnosis of RBD: Parkinson's disease, multiple system
atrophy, progressive supranuclear paralysis, Alzheimer's and Lewy
body dementia. We used randomly chosen controls matched for age,
gender and municipality.
Results: 246 iRBD patients and 982 matched controls were analyzed.
The mortality rate was the same in both groups. The morbidity rate
was significantly higher in the years before and after an RBD diagno-
sis, due to a wide variety of disorders in the following major disease
groups: mental/behavioral disorders, endocrine/metabolic diseases,
diseases of the eye, diseases of the nervous, digestive, musculo-
skeletal, circulatory and respiratory systems, abnormal findings not
classified elsewhere, external causes, and factors influencing health
status. The conversion rate from RBD to a neurodegenerative dis-
ease was 13% over the 8 years after a diagnosis of RBD.
Comorbidities found before and after the index date were each ana-
lyzed by conditional logistic regression. Kaplan-­Meier survival analy-
sis was used to estimate the survival distribution function and the
number of iRBD patients who received a diagnosis of a neurodegen-
erative disorder during the 3 years following the index date. A Cox
proportional hazards model was used to estimate the hazard ratio.
Conclusions: A diagnosis of RBD is associated with increased mor-
bidity several years before and after a diagnosis is made. Patients
have a higher risk of converting to a neurodegenerative disorder
than matched controls. Mortality rates are unchanged.
Disclosure: Nothing to disclose.
P497 | Effects of temporal lobe epilepsy
surgery on sleep macrostructure and
microstructure
A. Romigi1; A. d'aniello1; M. Caccamo1; F. Testa1; G. Vitrani1;
L. Grammaldo2; M. De Risi2; V. Esposito2; D. Centonze1; G.
Di Gennaro2
1
Sleep Medicine Center; 2Epilepsy Surgery Center, IRCCS Neuromed
Istituto Neurologico Mediterraneo Sleep Medicine Centre Pozzilli,
Pozzilli, Italy
Objectives/Introduction: To evaluate the effect of anterior tempo-
ral lobectomy (ATL) for temporal lobe epilepsy (TLE) associated with
hippocampal sclerosis on sleep architecture of drug-­resistant adult
patients.
Methods: Fifteen patients affected by TLE refractory to antiseizure
medications underwent surgical treatment. Patients were evaluated
before ATL (T0), after 4 weeks (T1) and 1 year (T2) with full-­PSG
study, subjective evaluation of nocturnal sleep (PSQI) and daytime
sleepiness (ESS). Healthy controls (HC) matched for age, sex and BMI
|
      309 of 356
were recruited. Scoring and analysis of sleep macrostructure and cy-
clic alternating pattern (CAP) parameters were performed.
Results: Thirteen patients completed the study. The analysis of the
CAP showed a significant reduction of CAP rate (%) in N3 both in T1
(T1 68 ± 11.6; p = 0.01) and in T2 (T2 66.7 ± 13.8 p = 0.009) com-
pared to the basal condition (T0 80.7 ± 12.7), A3 component (%) both
in T1 (T1 9.3 ± 3.63; p = 0.002) and in T2 (T2 10.1 ± 3.2 p = 0.008)
compared to basal condition (T0 15.3 ± 4 , 8), A3 index (n/h) both
in T1 (T1 3.5 ± 1.77; p = 0.0008) and in T2 (T2 4.3 ± 2.2 p = 0.003)
versus basal condition (T0 9.7 ± 4.78) and a significant increase of
the duration of phase B (sec) both in T1 (T1 23.9 ± 2.35; p = 0.01)
and in T2 (T2 24, 4 ± 1.7 p = 0.003) compared to basal condition (T0
21.5 ± 2.4) and cycle mean duration (sec) both in T1 (T1 30.7 ± 2.3; p
= 0.02 ) and in T2 (T2 31.5 ± 1.9 p = 0.002) with respect to the basal
condition (T0 28.3 ± 2.5). Finally, a significant reduction of CAP cy-
cles per sequences (n) was observed in T2 (8.3969 ± 1.99, p = 0.02)
compared to T0 (10.9 ± 2.61) and increase of A1% in T1 (71.7 ± 4.8)
vs T0 (62.08 ± 9 p = 0.01).
Conclusions: ATL does not affect sleep macrostructure, while may
improve CAP parameters after 4 weeks and 1 year as an expression
of higher sleep continuity and lower sleep fragmentation that could
play a role in clinical outcome of TLE patients after anterior temporal
lobectomy.
Disclosure: Nothing to disclose.
P498 | Influence of chronic radiofrequency
electromagnetic fields exposure on cerebral
oxygenation in preterm neonates: preliminary
results
D. Besset1; B. Selmaoui1; S. Delanaud1; R. de Seze1; A.
Léké1,2; E. Stéphan-Blanchard1
1
PériTox Lab, University of Picardie Jules Verne; 2Neonatal Intensive
Care Unit, University Medical Center Amiens Picardie, Amiens, France
Objectives/Introduction: While hospitalized, preterm neonates are
chronically exposed to low levels of radiofrequencies (RF) through
multiple wireless communicating devices. Some studies in adults
have suggested an effect of RF on cerebrovascular functions.
However, it has never been tested in a more vulnerable population
such as preterm neonates whereas alteration of cerebral oxygena-
tion by RF exposure may disrupt their neurophysiological devel-
opment. We investigated the influence of chronic RF exposure on
cerebral oxygenation in preterm neonates.
Methods: Individual, continuous measurements of RF levels were
performed on 24 preterm neonates (gestational age: 29 ± 2 wk, birth
weight: 1220 ± 314 g) during the first 3 weeks after birth. Individual
RF exposure level over the whole recording period was expressed
as the median and the 99.9th percentile (P99.9, 0.1% of the highest
values). An overnight polysomnography, including the recording of
peripheral (SpO2, pulse oximetry) and cerebral (rScO2, near-­infrared
 |
310 of 356       ABSTRACTS
spectroscopy) oxygen saturation, was performed on the last day of
measurements. Fractional tissue oxygen extraction (cFTOE) was
also calculated: cFTOE = (SpO2 -­rScO2) /SpO2. Linear relationships
were computed between RF exposure levels and oxygenation pa-
rameters according to Rapid Eye Movement (REM) and non-­REM
(NREM) sleep stages.
Results: The mean exposure values for the median and P99.9 were
0.03 ± 0.01 and 0.65 ± 0.27 respectively. Sleep stages had no sig-
nificant influence on SpO2 (REM: 95 ± 4%, NREM: 96 ± 4%), rScO2
(REM: 68 ± 9%, NREM: 69 ± 9%) and cFTOE (REM: 0.29 ± 0.09%,
NREM: 0.28 ± 0.09%). No significant relationship was found be-
tween the RF median level and P99.9, and either SpO2, rScO2 or
cFTOE.
Conclusions: These preliminary results showed that neither cerebral
oxygen saturation nor the amount of oxygen extracted by the tis-
sue was correlated with the level of RF exposure, suggesting that
cerebrovascular function of preterm neonates is not altered when
exposed to chronic, low levels of RF during early life.
Disclosure: Nothing to disclose.
P499 | Sleep habits among a sample of
preschool children with psychiatric diagnoses
J. Mauricio1; S. Araújo2; S. Rodrigues2; F. Lopes2; R. Costa3;
G. Dias2; V. Miranda2; G. Fernandes2
1 2
Psychiatry, ULSAM, Viana do Castelo; Child and Adolescent
3 and the level of school performance among secondary education
Psychiatry, CMIN; Family Medicine, USF Anibal Cunha, Porto,
Portugal
Objectives/Introduction: Document the parental perception of
sleep problems in pre-­
schoolers assessed at a childhood mental
health outpatient clinic.
Sleep plays an integral role in the normal development of children
and this relationship is particularly relevant in vulnerable popula-
tions. Studies have reported poor sleep quality to be related to
school performance, physical and mental development, behaviour
difficulties and child´s cognition. Moreover, sleep plays a crucial role
in the maintenance of optimal mental health.
Methods: A cross-­sectional questionnaire survey of 41 child psychi-
atric outpatients’ children. Children´s Sleep Habits Questionnaire
Portuguese version (CSHQ-­PT) was used in clinical setting to assess
children ages 2 to 6 years old for the presence of sleep problems.
Results: A total of 41 children participated. Mean age was 3.7 years
(42% girls, 58% boys). Average night-­time sleep duration was 9 h
45 min, being longer in younger kids (p < 0.002). During working-­
days mean bedtime was 21 h 45 min and mean wake-­up time was
7 h 45 min. During weekends mean bedtime was 22 h and wake-­up
time 09 h. 68% of parents felt that their child did not have a sleep
problem and 75% perceived that their child's sleep duration was
adequate. The prevalence of global sleep disturbances was 80.4%.
Mean CSHQ-­PT total score was 55.4 and there was no significant
age correlation. The most common sleep problems were in the
domain of bedtime resistance, with 73% requiring company to fall
asleep, 51% fall asleep in other's bed and 46% struggles at bedtime.
Parasomnias also registered high prevalence (78% of parents noticed
restlessness/ movement, 46% grinds teeth and 41% somniloquy).
Conclusions: Sleep problems are common among the sampled popu-
lation. Parent's perception of disturbed sleep has been found to be
lower than the percentage of sleep disturbances identified by the
CSHQ. Bedtime resistance and parasomnias seem to be common
among these children. These results emphasise the need to further
study the relationship between sleep and psychiatric disorders in
this vulnerable population in order to address more specific and ap-
propriate treatment interventions, diagnosis and future sleep quality.
Disclosure: Nothing to disclose.
P500 | Sleep habits among adolescents in
southern Greece
M. Fountoulaki; S. Klimis; E. Kondili; A. Alegakis; C.
Alexopoulou
University Hospital of Heraklion, Heraklion, Greece
Objectives/Introduction: Insufficient sleep and unhealthy sleep
behaviors have been described in adolescents. This study aimed to
investigate sleep habits, possible factors contributing to sleep loss,
students in Heraklion, Crete, Greece.
Methods: Cross-­
sectional, community-­
based study with a self-­
reported questionnaire. 831 students (age 13–19) participated in
the study by completing an online questionnaire. The analysis was
performed among the six years of Secondary Education separated
in two groups corresponding to 3 years of Gymnasium and Lyceum
each, according to the Greek educational system.
Results: 583 of 831 participants in the study (70.2%) were Lyceum
students. Overall, in all students, the sleep duration on weekdays was
7 ± 1.1 hours (mean ± SD), significantly lower than that observed on
weekends (7.8 ± 1.5, p < 0.001).A significant decrease in sleep dura-
tion was found between students in the 1st year of Gymnasium and
the 3rd year of Lyceum (7.7 ± 1.1 and 6.6 ± 1.0 hours, respectively,
p < 0.001). Difficulties of awakening were present in 656 students
(78.9%) who also had less sleep duration. 613 (73.8%) of students
reported feeling sleepy at school for at least 1 day/week, and 309
(37.2%), for more than 2 days/week. Using electronic devices before
sleep was reported by 529 students (63.7%) with a significant dif-
ference between boys and girls (69.6% and 57.6%,respectively, p <
0.001).
Sufficient sleep time (≥8  hours) was found to have a positive cor-
relation with student's grades (OR: 1.48 CI 1.06–2.07, p = 0.022).
Sufficient sleep was positively correlated with the frequency of
physical exercise (never/rarely 13.5%, sometimes 21.2% and often
65.3%, p = 0.002) and negatively correlated with smoking (OR: 0.29,
ABSTRACTS
CI 0.13-­0.63) and alcohol consumption (OR: 0.51, CI 0.36-­0.71), p =
0.001).
Conclusions: Sleep deprivation is confirmed in our population and
is correlated with signs of day-­time sleepiness. Sleep duration was
lower than the recommended 8 hours and significantly decreased in
the 3rd year of Lyceum. Sleep duration of ≥8 hours was associated
with better school performance. Sufficient sleep is positively cor-
related with the frequency of physical exercise and negatively cor-
related with social habits such as smoking and alcohol consumption.
Disclosure: Nothing to disclose.
P501 | Prevalence of cancer in Greek
obstructive sleep apnea patients
K. Baou; M. Vagiakis; A. Minaritzoglou; E. Florou; E. Vagiakis
Critical Care and Pulmonary Services, Sleep Disorders Center,
University of Athens Medical School, Evangelismos Hospital, Athens,
Greece
Objectives/Introduction: Obstructive sleep apnea (OSA), a major
health problem worldwide, might increase the risk of incident cancer.
A growing body of literature, during the last decade, has examined
the role of OSA in the carcinogenesis. The numerous conclusions
from different studies were highly variable. In this study, it was ex-
amined the prevalence of OSA patients with cancer and the special
characteristics in this group of patients.
Methods: A total of 280 patients with OSA undergoing clinical, and
sleep study evaluation were studied. The diagnosis of OSA was es-
tablished when the Apnea-­Hypopnea Index(AHI) was ≥5 event/
hour on the attended overnight polysomnography. Sleepiness was
assessed by the Epworth Sleepiness Scale (ESS). A ESS score of 11 or
higher represented EDS.
Results: 15 patients (5.3%) were identified with a history of cancer,
1 patient had 2 types of cancer. Specifically, 2 patients had (0.7%)
ENT cancer, 6 patients (2.1%) prostate cancer, 1 patient (0.3%) had
hematology cancer and 1 (0.3%) patients had kidney cancer, 2 pa-
tients (0.7%) had lung cancer, and 4 patients (1.4%) suffered from
breast cancer or genital cancer. Patients with OSA and cancer were
older 66 ± 7 vs 54 ± 12 years (p < 0.001), they did not present EDS
(suggestive p = 0.08) and most of them (93%) had hypertension (p
< 0.001) compared to the rest OSA patients. They did not differ on
gender, BMI, AHI or other parameters from the sleep study. Eight of
them had no smoking history, and 7 were ex-­smokers.
Conclusions: Interesting enough, the risk of cancer in Greek patients
with OSA was increased compared to the results of other epidemio-
logical studies on the general population. Additionally, it is important
to understand the nature of this association and the important de-
terminants who interfere in this association.
Disclosure: Nothing to disclose.
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P502 | Nocturnal blood pressure fluctuations
in obstructive sleep apnea
M.J. Pablo Zaro; I. Benavente Aguilar; Y. Lasierra Périz; F.
Romero Puertas; V. Majarenas Mascuñano; J.C. Sanjuán
Abián; L. Borderías Clau; E. Briz Muñoz
Sleep Unity, Hospital San Jorge Huesca, Huesca, Spain
Objectives/Introduction: Patients with obstructive sleep apnea
(OSA) with episodes of systolic blood pressure increase during night
sleep, with and without hypertension were studied. Hypertension
was considered a risk vascular factor in a prospective study. The ob-
jective of this study was to confirm that patients with OSA with hy-
pertension had higher vascular risk than patients without high blood
pressure.
Methods: Different biometric parameters were analyzed in 44 pa-
tients with OSA with episodes of systolic blood pressure increase
during sleep, 28 with hypertension and 16 without high blood pres-
sure. The studied parameters were: Body Mass Index (BMI), Basal
Blood Pressure, and polysomnographic: AHI (Apnea-­hypopnea/hour
Index), Oxygen Desaturation Index, Arousal Index, Basal and mini-
mal oxygen Saturation, and proportion of the different sleep stages,
among others. Comorbidities and associated treatments were stud-
ied as well, at the moment of the polysomnographic study (2013 to
2015), and nowadays (2020).
Results: No statistically significant differences were found between
both groups in the different studied parameters. Patients of both
groups developed comorbidities in the follow up period, more fre-
quent in the hypertension group, requiring new treatments, above
all in the group of patients with high blood pressure.
Conclusions: Systolic blood pressure increase during sleep episodes
suggested more vascular risk in patients with Sleep Apnea with hy-
pertension in order to associated comorbidities.
Disclosure: Nothing to disclose.
P503 | Screening and awareness of obstructive
sleep apnea: from bench to society
B. Santos1,2; L. Gaspar1,2,3; C. Carvalhas-Almeida1,2; R.
Lopes1,2; A. Santos-Carvalho1,2,4; A.T. Barros-Viegas1,2,4; C.
Cavadas1,2,5; A.R. Álvaro1,2,4
1
Neuroendocrinology and Aging, Centro de Neurociências e Biologia
Celular; 2Center for Innovation in Biomedicine and Biotechnology
(CIBB); 3PDBEB -­Doctoral Programme in Experimental Biology and
Biomedicine; 4Institute for Interdisciplinary Research (IIIUC); 5Faculty
of Pharmacy, University of Coimbra, Coimbra, Portugal
Objectives/Introduction: Obstructive Sleep Apnea (OSA) is amongst
the most common sleep disorders worldwide. Still, 80 to 90% of its
cases are undiagnosed, in part due to poor disease awareness and
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312 of 356       ABSTRACTS
symptoms reporting. Untreated OSA strongly impacts life quality
and promotes several diseases, such as cardiovascular and meta-
bolic diseases. Among the highest risk groups are men, overweight
individuals, smokers and shift workers. Transport companies and
industries that work uninterruptedly have been associated to high
risk groups. In this context, in collaboration with the Sleep Medicine
Center of Coimbra Hospital, Portugal and other Portuguese com-
panies, we did awareness campaigns about OSA among risk groups,
contributing to earlier OSA diagnosis.
Methods: Several conferences about OSA were given in different
companies in Coimbra, including the Municipality of Coimbra, Urban
Transport Services (SMTUC), and Environment Division. Employees
(n = 214) were invited not only to assist but also to participate
voluntarily in the study, by filling validated sleep questionnaires
(STOP-­BANG and Epworth Sleepiness Scale). The answers will give
information about the volunteers inquired, regarding clinical history
(diseases, medication), lifestyle (exercise, diet), sleep quality/habits
and to identify potential OSA patients.
Results: Our data show that 32 % of all participants have excessive
sleepiness throughout the day and 42 % have high risk of suffer-
ing or developing OSA. The great majority of the participants (81 %)
has a body mass index (BMI) above the recommended by the World
Health Organization.
A combined analysis of questionnaires showed that 76 % of the par-
ticipants with high BMI have high risk of suffering from or devel-
oping OSA (STOP-­BANG score ≥ 3). Following these results, within
each company, potential OSA patients were selected and accompa-
nied by each company occupational health services.
Conclusions: Together with sleep and primary care physicians, com-
panies and workers, we created an awareness network with impact
on OSA diagnosis. This network gives the possibility for each sub-
ject to actively contribute to OSA research, enriching their health
literacy and increasing scientific culture.
Disclosure: Nothing to disclose.
P504 | Sleep and sleep disorders in a sample of
200 older adults
E. Martin Abad; E. Rocio Martin; R. Wix Ramos
Hospital La Princesa, Madrid, Spain
Objectives/Introduction: Sleep complaints and their negative ef-
fects on physical and mental well-­being are common in older adults.
Developmental changes in elderly sleep are characterized by ad-
vanced sleep phase, reduced sleep consolidation and altered sleep
architecture with lighter sleep. Numerous chronic diseases and
drugs are known to be associated with sleep disruption.
Describe demographic data and clinical spectrum, medical patholo-
gies associated, and the drugs consumption that interact with sleep.
Including psychological tests and polysomnography parameters of
patients ≥65 years old of our center.
Methods: 200 consecutive patients ≥65  years old of our sleep
unit. Demographic and anthropometric data, scores on sleep-­
questionnaires (Epworth Sleepiness Scale; Insomnia Severity Index),
psychological tests (Beck Depression Inventory II; moderate-­severe
20–63), State-­Trait Anxiety Inventory; positive above 50th percen-
tile. Polysomnography parameters was made according American
Academy of Sleep Medicine and diagnosis of sleep disorders accord-
ing to International Classification of Sleep Disorders Third Edition
criteria.
Results: A sample of 200 patients ≥ 65 years old, finding that sleep
disorders in the elderly are more common in males (60.62%), fe-
males (39.37%). They have a high rate of cardiovascular risk fac-
tors: overweight/obesity (73%), hypertension (54.5%), dyslipidemia
(44%) or diabetes mellitus (24.5%) and significant use of drugs with
sleep interaction (44%); benzodiazepines (50%). Polysomnography
findings found decreased sleep efficiency (72.07%), total sleep
time decreased (325.57 minutes), increased wake after sleep onset
(90.23 minutes), increase N1 and N2 NREM sleep (69.77%) and de-
crease of REM sleep (13.53%), compared to the average values of
the adult population. Sleep disorders found were: sleep apnea syn-
drome (87%), periodic leg movement syndrome during sleep (46.5%),
chronic insomnia (20.5%), restless leg syndrome (17.5%) and REM
sleep behavior disorder (6%). As for test, moderate/severe daytime
sleepiness (18%), moderate/severe depression (6%), anxiety trait
(13%) and anxiety state (12%) and in patients with insomnia; 59%
moderate/severe clinical insomnia.
Conclusions: Primary sleep disorders are very common in older
adults and generally is related to medical or psychiatric illness, use
of certain medications, circadian rhythm and sleep homeostatic
changes, rather than to aging per se. A significant percentage of pa-
tients use drugs with sleep interaction, highlighting the use of ben-
zodiazepines chronically.
Disclosure: Nothing to disclose.
P505 | Differences between two groups of
patients with sleep apnea: with and without
cardiovascular comorbidity
J. F Lahera; M. Blanco Beltran; L. Alvarez Santin; B. Sanchez;
A. Quezada; M. Ferreiro
Hospital HM Montepríncipe, Madrid, Spain
Objectives/Introduction: To study in patients diagnosed with sleep
apnea if there are significant differences between two groups of pa-
tients: group 1 with cardiovascular comorbidity and group 2 without
cardiovascular comorbidity. Cardiovascular comorbidity was consid-
ered in the presence of cardiovascular disease and/or having 3 or
more cardiovascular risk factors.
Methods: In the study were included 114 participants. Clinical
parameters (age, gender, body mass index, Mallampati degrees,
Epworth test), biochemical parameters (cholesterol, triglycerids,
ABSTRACTS
glucose, glycated hemoglobin, insulin, HOMA index, uric acid, C-­
Reactive Protein, NT-­proBNP, homocysteine, TSH). Sleep study was
performed (polysomnography or respiratory polygraphy).
In the statistical analysis we applied the chi square test, ANOVA,
Pearson correlation and a linear and logistic regression analysis.
Results: Patients with cardiovascular comobidity had greater sig-
nificant alterations in the following parameters in comparison to
patients without comorbidity: age, body mass index, Mallampati
degrees, apnea-­hypopnea index (AHI), oxygen desaturation index
(ODI), mean oxygen saturation (mean SpO2), insulin resistance index
(HOMA-­IR), uric acid, NT proBNP, homocysteine and lower total
cholesterol.
In a correlation analysis, the number of cardiovascular risk factors
had a direct correlation with the AHI (r = 0.22, p = 0.02), ODI (r =
0.29, p = 0.003) and the inverse correlation with mean SpO2 (r =
−0.25; p = 0.012).
In a logistic regression model, the mean SpO2 variable was sig-
nificant as a predictor of cardiovascular comorbidity (OR 0.79; p =
0.005).
Conclusions: The group of patients with sleep apnea and cardiovas-
cular comorbidity presented greater alterations in sleep respiratory
parameters and in some clinical and metabolic characteristics com-
pared to the group without cardiovascular comorbidity.
Disclosure: Nothing to disclose.
P506 | Sleep -­a family topic? Parenting style,
parenting sleep and sleep disturbances of their
children
A.A. Schlarb1; F. Lollies2; J. Faber2
1
Psychology | Clinical Psychology and Intervention; 2Bielefeld
University, Bielefeld, Germany
Objectives/Introduction: According to various studies, about 15–
41% of school-­age children suffer from sleep problems. In addition
to the risk of these difficulties becoming chronic, sleep disorders
in children are associated with mental, physical and developmental
problems The transactional model of infant sleep not only includes
context factors and intrinsic infant factors, but as well focus on
parent-­child interaction and parenting factors. Parental behavior
and competence for managing sleep problems of their child seem
to be a relevant factor to cope with sleep problems. The goal of
this study was to assess parenting styles and dimensions regarding
sleep of the child and to evaluate the role of parental disturbed sleep
within this association.
Methods: Parents of children with sleep disturbances (N = 160,
children aged 5–10 years (M = 6.79 years) were assessed. Parenting
style were evaluated with the German version of the Alabama
Parenting Questionnaire for school-­children (DEAPQ-­EL-­GS), sleep
quality was assessed with PSQI and children's sleep problems with
the Children Sleep Habits Questionnaire (CSHQ).
|
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Results: Problematic parental behaviour was associated with signifi-
cantly more sleep problems in children -­especially sleep duration. In
detail, inconsistent parental behaviour (t = 2.82, p = 0.005) and less
parenting monitoring (t = 2.39, p = 0.018) were negative predictors
concerning impaired sleep duration of the children. Beyond, more
parental sleep problems were associated with higher impact of pa-
rental behaviour on the sleep problems of the child (β = −0.05, p =
0.05), R2 = 0.11.
Conclusions: Concerning sleep problems in childhood, not only chil-
dren should be addressed, also parenting behaviour should be fo-
cused within treatment.
Disclosure: Nothing to disclose.
P507 | Prevalence of anxiety and depressive
symptoms among a sample of obstructive sleep
apnoea non treated patients
J. Mauricio1; V. Melo2; E. Lombardia2; I. Gonçalves2; R.
Neveda2
1
Psychiatry; 2Respiratory Medicine, ULSAM, Viana do Castelo,
Portugal
Objectives/Introduction: Study the prevalence of anxiety and de-
pressive symptoms in obstructive sleep apnoea syndrome (OSAS)
non treated patients. Investigate the association between the pres-
ence of these symptoms and OSAS severity.
In recent years, OSAS has become a common and serious problem
and when left untreated is connected with comorbid conditions
Accumulating evidence indicates that OSAS is associated with a high
prevalence of anxiety and depressive symptoms in both community
and clinical populations.
Methods: Male patients with newly diagnosed OSAS before any
treatment and without any medical comorbidities (except over-
weight) were included. All patients were asked to complete the
Hospital Anxiety and Depression Scale (HADS) questionnaire.
Severity of breathing disorder was classified as mild, moderate, and
severe based on apnoea-­hypopnea index (AHI) which was ascer-
tained by overnight polysomnography.
Results: Of the 52 participants in the cohort, mean age was
58.8 years (SD 8.7); mean weight 91.9 kg (SD 11.9); mean body max
index 30.9 (SD 3.62) and AHI 34.4 (SD 19.44). 92% patients were
overweight (BMI > 25). SAOS severity: 3.8% of the cases were mild,
46.2% moderate and 50 % severe. Around 88% had a positive HADS
(score > 16/42). 100% of the individuals had some degree of anxiety,
while 48% demonstrated some degree of depressive symptoms. No
correlation was found between OSAS severity and HADS score (p
= 0.17).
Conclusions: Anxiety and depressive symptoms are high prevalent
features in this sample. These high values can be explained by the
overestimation of complains in mood scales compared to psychiat-
ric interviews, so interdisciplinary cooperation is recommended in
these patients. Symptoms of emotional distress can have a negative
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314 of 356       ABSTRACTS
impact in the disease process, conditioning compliance to therapy.
Physicians must be aware of this in order to deliver an effective and
comprehensive treatment.
Disclosure: Nothing to disclose.
P508 | A systematic review of objective
sleep problems in persistent tic disorders and
attention-­deficit hyperactivity disorder
L. Keenan; C. Sherlock; J. Bramham; M. Downes
School of Psychology, University College Dublin, Dublin, Ireland
Objectives/Introduction: Persistent tic disorders (PTDs) and
attention-­deficit hyperactivity disorder (ADHD) are common neu-
rodevelopmental conditions, both of which are associated with sleep
problems. PTDs and ADHD frequently co-­occur with one another
and there is evidence for a shared genetic basis, but the disorders
tend to be researched in different fields. Findings from objective
sleep studies across both populations have yet to be synthesised,
limiting our understanding of the impact of co-­occurring ADHD in
PTDs or vice-­versa. This systematic review aims to assess the state
of the literature and identify potential disorder-­specific sleep distur-
bances based on objective measures.
Methods: PubMed, Scopus, Embase, and PsycINFO were searched
to identify studies using objective sleep measures (i.e. actigraphy,
polysomnography [PSG]) in PTDs and/or ADHD. Retrieved studies
were screened based on pre-­defined inclusion criteria. Studies must
have included measures used in both populations to allow for com-
parison. Methodological quality was assessed using the STROBE
checklist.
Results: No actigraphy studies with PTDs were identified for in-
clusion. PSG was the only measure used in both populations, with
adaptation nights used in all but one of the PTD studies retrieved.
This resulted in 22 studies meeting the final inclusion criteria, four of
which included a group with PTD co-­occurring with ADHD. Findings
are therefore divided into PTD-­only (N = 108), ADHD-­only (N = 305),
and PTD+ADHD (N = 79). Compared to typically-­developing con-
trols, differences in standard sleep parameters were found in each
patient population in the majority of studies. While there was het-
erogeneity in specific findings, ADHD studies tended to find differ-
ences in parameters including time in bed, sleep period time, and
total sleep time. Lower sleep efficiency in PTDs emerged as a poten-
tial disorder-­specific issue. The most significant differences in sleep
parameters were in PTD+ADHD populations.
Conclusions: PTDs and ADHD are associated with sleep problems
based on standard sleep parameters, with PTD co-­occurring with
ADHD appearing to compound these problems. Future efforts
should address the disparity in research focus between disorders,
ensuring actigraphy is incorporated to allow for more naturalistic
comparisons. Additional studies with PTD-­only, ADHD-­only, and
PTD+ADHD are also required to further elucidate disorder-­specific
sleep problems.
Disclosure: Nothing to disclose.
P509 | Italian Multicenter study on circadian
and sleep alterations measured by activity
trackers as markers of mild cognitive impairment
and Alzheimer's disease: focus on sex differences
M. Maestri1; B. Guarnieri2; F. Cucchiara3; A. Lo Gerfo1; A.
Schirru1; D. Arnaldi4; P. Mattioli4; F. Nobili4; G. Lombardi5;
G. Cerroni2; A. Bartoli2; R. Manni6; E. Sinforiani7; M.
Terzaghi6; M.G. Arena8; R. Silvestri8; C. La Morgia9; M.C. Di
Perri8; F. Franzoni1; G. Tognoni1; M. Mancuso1; S. Sorbi5; U.
Bonuccelli1; G. Siciliano1; U. Faraguna3; E. Bonanni1
1
Department of Clinical and Experimental Medicine, Pisa; 2Center
of Sleep Medicine, Villa Serena Hospital, Città S. Angelo, Villaserena
Foundation for the Research, Pescara; 3Department of Translational
Research and of New Surgical and Medical Technologies, SonnoLAB,
University of Pisa, Pisa; 4Clincial Neurology, Department of
Neuroscience, University of Genoa, Genoa; 5Department of
Neuroscience, Psychology, Drug Research and Child Health, University
of Florence, Florence; 6Unit of Sleep Medicine and Epilepsy, IRCCS
Mondino Foundation; 7Neuropsychology/Alzheimer's Disease
Assessment Unit, IRCCS C. Mondino Foundation, Pavia, Pavia; 8AOU
Policlinico ‘G. MArtino’, University of Messina, Messina; 9IRCCS Istituto
delle Scienze Neurologiche, Ospedale Bellaria, Bologna, Italy
Objectives/Introduction: Multiple forms of circadian and sleep dis-
turbances are associated with an increased risk of developing mild
cognitive impairment (MCI) and Alzheimer's Disease (AD). Wearable
activity trackers could help understand the underlying pathophysiol-
ogy and provide a new approach in diagnosis and prevention.
Objective: To evaluate differences in sleep parameters and circadian
rhythms, through wearable activity trackers, in patients with MCI
and AD as compared to controls, focusing on sex dissimilarities.
Methods: Based on minute level data obtained from consumer wear-
able devices, we analyzed actigraphic sleep parameters by applying
an electromedical type I registered algorithm, and the corresponding
circadian variables in 158 age-­matched subjects, 86 females and 72
males (42 AD, 28 MCI, and 88 healthy volunteers). Moreover, we
used a confusion-­matrix chart method to assess accuracy, precision,
sensitivity, and specificity of two decision-­tree models based on ac-
tigraphic data in predicting disease (MCI or AD) or health status.
Results: Wake after sleep onset (WASO) resulted significantly higher
(p < 0.001) and sleep efficiency (SE) significantly lower (p = 0.003)
in MCI subjects and Sleep Regularity Index (SRI) was significantly
lower in AD patients compared to controls (p = 0.004). Sex differ-
ences were also found: SE significantly lower in male AD compared
to female AD subjects (p = 0.038) and SRI significantly lower in male
ABSTRACTS
AD subjects compared to male controls (p = 0.008), to male MCI (p =
0.047) but also to female AD subjects (p = 0.046).
Regarding circadian indexes, mesor and rhythm quotient were sig-
nificantly lower in males in the overall population, but not in the
analysis for separate groups.
The confusion-­
matrices showed a good predictive power of ac-
tigraphic data in forecasting the disease status with acceptable
representativeness.
Conclusions: Actigraphic data could help identify disease (AD or
MCI) or health status. Sex (possibly gender) differences could have
a relevant impact on neurodegeneration and disease trajectory with
potential clinical applications.
Disclosure: This multicenter study was conceived and promoted by
the Italian Association of Sleep Medicine (AIMS) in close collabora-
tion with the Italian Society for Dementia Research (SINdem) and co-
ordinated by the Department of Clinical and Experimental Medicine,
Neurology Unit, University of Pisa. U.F. is CEO of sleepActa s.r.l., a
University of Pisa Spinoff private company, focused on sleep wear-
able diagnostics.
P510 | Female monozygotic twins affected
with Kleine-­Levin syndrome
R. Peraita-Adrados1; L. Lillo-Triguero2; P. Medrano-
Martínez3; J.L. Vicario 4; A. Balas4
1
Sleep and Epilepsy Unit-­Clinical Neurophysiology Service, University
General Hospital Gregorio Marañón. Research Institute Gregorio
Marañón. Complutense University of Madrid; 2Neurology and Sleep
Unit, Ruber International Hospital; 3Education and Psychology
Department, Cardenal Cisneros University Center. Alcalá de Henares.
Madrid; 4Histocompatibility, Blood Center of the Community of
Madrid, Madrid, Spain
Objectives/Introduction: To report a unique pair of Spanish female's
monozygotic twins affected with Kleine-­Levin syndrome.
Methods: The twin sisters were referred to the Sleep Unit due to re-
current hypersomnia, depression and anxiety. Other sleep disorders
were not found in a four non consanguineous generations except a
somnambulism in their older brother.
A complete examination and laboratory work-­up including PSG fol-
lowed by MSLT, cranial MRI, HLA-­t yping and additional markers was
performed.
Results: Case 1, was the first-­born twin. Past medical history of som-
nambulism, enuresis, anemia, subclinical hypothyroidism and two in-
guinal hernias removed. Her first attack occurred at the age 12, and
her last attack occurred -­last December-­at the age of 23, Clinical
features: recurrent bouts of hypersomnia associated with anorexia,
cognitive symptoms, depression and anxiety, irritability, confusion,
feeling of unreality, profuse sweating, and transient elation and in-
somnia at the end of episodes with a mean duration of 8 days and no
coincident with the menses. Mean number of 2 episodes per year.
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Case 2, was the second-­born twin. Past medical history of paras-
omnias, migraines, hypothyroidism and two inguinal and umbilical
hernias removed. Her first attack occurred at the age of 13, in the
context of rhinitis, and her last attack last January. Clinical features:
recurrent hypersomnia, anorexia, odd behavior, cognitive symptoms,
speech difficulties, depression and anxiety, fear, transient partial
amnesia, and insomnia at the end of episodes. She presented 4 epi-
sodes per year lasting 9 to 15 days. Neurological examination and
standard EEGs were normal in both sisters. PSGs in asymptomatic
period showed a normal sleep and MSLTs were negative. HLA typ-
ing: A*26, A*29/ B*44,-­/C*06, C*16/DRB1*07, -­/DQB1*02, -­; and 10
additional highly polymorphic markers for 9 chromosomes revealed
identical results, confirming monozygosity.
Conclusions: To our knowledge this is the first report of female's
monozygotic twins with Kleine-­Levin Syndrome. Although familial
cases of KLS are extremely rare [1, 2], our observation raises the
possibility of genuine genetic forms of KLS to be identified.
References:
1. Peraita-­Adrados R, et al. Monozygotic twins affected with Kleine-­
Levin syndrome. Sleep 2012.
2. Ueno T, et al. Monozygotic twins concordant for Kleine-­Levin syn-
drome. BMC Neurol 2012.
Disclosure: Nothing to disclose.
P511 | Comparison of Modafinil and Pitolisant
in narcolepsy: a non inferiority meta-­analytical
approach
C. Caussé1; P. Lehert2,3
1
Bioprojet Pharma, Paris, France; 2Faculty of Economics, University
of Louvain, Mons, Belgium; 3Faculty of Medicine, University of
Melbourne, Melbourne, Vic., Australia
Objectives/Introduction: Pitolisant is a new compound used in nar-
colepsy for the relief of Excessive Daytime Sleepiness (EDS) and
cataplexy. We assessed the non-­
inferiority of Pitolisant efficacy
compared with Modafinil.
Methods: Network meta-­
analysis compared efficacy and safety
of multiple treatments and multi-­arm studies. Epworth Sleepiness
Scale (ESS), Maintenance of Wakefulness Test (MWT), the Weekly
Rate of Cataplexy (WRC) and safety constituted the main endpoints,
EDS and Narcolepsy Z-­scores and Benefit/Risk ratios considered as
supportive measures. Pre-­determined non inferiority margins of 1
score, and 1 minute was fixed for the comparison of ESS and MWT,
respectively.
Results: Among 312 articles, 10 Randomised Clinical Trials (RCTs)
were assessed and eligible for network meta-­analysis. For ESS, a
non-­significantly superior beneficial decrease of −0.69 ([−2.18, 0.79])
in pitolisant arm provided evidence of non-­
inferiority compared
with a Non Inferiority Margin (NIM) = 1 (p = 0.015). A MWT ben-
eficial increase of 2.12 minutes ([−0.95,5.19], p = 0.18) in pitolisant
 |
316 of 356       ABSTRACTS
arm compared to placebo, showed non-­inferiority compared with
NIM  =  −1. For cataplexy, the pitolisant effect was −0.49 ([−0.86,
−0.12], decrease of WRC = −4.3, p = 0.012), significantly superior to
modafinil in addition of non-­inferiority. The Risk Ratio of Treatment
suspected adverse events pitolisant/modafinil was RR = 0.86 [0.44,
1.24] in favor of pitolisant confirming non inferiority considering a
safety margin of RR = 1.25 (tolerance of 25%).
For Narcolepsy Type1 patients, a significant benefit was found in
favor of pitolisant of 0.49 ([0.08, 1.03], p = 0.02). For Narcolepsy
Type2 patients, the observed benefit pitolisant was 0.24 ([−0.19,
0.70]) considered as non-­inferior based on NIM = 0.2.
Conclusions: Modafinil produced a significant improvement in EDS
(ESS and MWT), and an acceptable safety profile, without signifi-
cant effect on cataplexy. Pitolisant is shown as non-­inferior than
modafinil in relieving EDS, and superior to modafinil in reducing the
occurrence of cataplexies, thus pitolisant outranks modafinil when
prescribed to Narcolepsy type 1 patients. In spite of a slight superi-
ority of pitolisant in EDS relief, the two drugs can be considered as
equally performing for the treatment of Narcolepsy type 2 patients.
Disclosure: Bioprojet sponsored this analysis. C Caussé is an em-
ployee of bioprojet pharma P Lerhert received honoraria from
bioprojet
P512 | Pupillary reactivity to blue light as
a biomarker of depression in patients with
idiopathic hypersomnia
H. Rach1; E. Reynaud1,2; Ü. Kilic-Huck1,2; F. Fuchs1,2; L.
Hugueny1,2; E. Peiffer2; A.-L. Haldemann-Houmeau2; V. Roy
deBelleplaine2; P. Bourgin1,2; P.-A. Geoffroy1,2,3
1
CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences;
2
Sleep Disorders Center & CIRCSom (International Research Center
for ChronoSomnology) – Strasbourg University Hospital, Strasbourg;
3
Department of Child and Adolescent Psychiatry, Paris Diderot
University – Paris VII, Paris, France
Objectives/Introduction: Hypersomnolence is a main public health
problem affecting about 8.4% of the general population. It is also
a shared core feature in major depressive disorder (MDD) and idi-
opathic hypersomnia (IH), with both disorders possibly being comor-
bid to the other. This complex interaction and share manifestations
explain difficulties met by clinicians to distinguish IH from MDD
in the absence of specific biomarkers. Non-­visual phototransduc-
tion and response to the light may be altered in both MDD and IH.
Melanopsin is a retinal photopigment crucial for conveying non-­
visual light information to the brain. We investigated the relation
between the melanopsin post-­
illumination pupil response (PIPR)
recorded after exposure to bright blue light and the severity of de-
pressive symptoms, but also between the severity of depressive
symptoms and sleep parameters in order to identify biomarkers of
depression in a homogeneous population with IH.
Methods: Twenty patients with IH (85% women, 29.9 yo +/− 2.35)
were included. IH and depressive episode were defined with DSM-­5
and ICSD-­3 criteria. Structured Interview Guide for Hamilton depres-
sion scale – Seasonal Affective Disorder version – Self Assessment
questionnaire assessed typical and atypical depressive symptoms
severity. Pupil area was measured with an infrared pupillometry
setup to obtain a reliable and validated melanopsin PIPR with alter-
nating periods of prolonged darkness, red and blue-­light exposures.
Sleep parameters were assessed through a 48-­hour polysomno-
graphic recording and a Multiple Sleep Latency Test. Pearson's or
Spearman's correlation coefficient was calculated to measure the
association between parameters.
Results: Severity of the typical depressive symptoms negatively cor-
related with the PIPR.
(r = −0.487; p < 0.05). No significant correlation was found between
the severity of the depressive symptoms and sleep parameters
which might be explained by the limited sample size.
Conclusions: Our findings show that a hyposensitivity to the blue
light predicts an increase of depressive symptoms severity in IH,
suggesting specific changes of melanopsin-­based photic regulation
with depression. This observation suggests that our melanopsin
PIPR may be an innovative state marker of depression severity in a
homogeneous population suffering from IH.
Disclosure: Nothing to disclose.
P513 | Intellectual efficiency of children with
narcolepsy-­cataplexy
M. Thieux1,2; A. Marcastel2; N. Vieux2; A. Guyon2,3; M.
Zhang3; S. Mazza4; A. Guignard-Perret2; S. Plancoulaine5; P.
Franco2,3
1
Integrated Physiology of the Brain Arousal (WAKING team), Lyon
Neuroscience Research Center; 2Pediatric Sleep Unit, Department
of Pediatric Clinical Epileptology, Sleep Disorders and Functional
Neurology, Hospices Civils de Lyon; 3Integrated Physiology of the Brain
Arousal (WAKING Team), Lyon Neuroscience Research Center; 4Health
Services and Performance Research (HESPER), Lyon; 5CRESS, INSERM,
INRAE, Paris University, Paris, France
Objectives/Introduction: To describe intellectual efficiency of chil-
dren with narcolepsy-­
cataplexy (NC) and to investigate whether
intellectual efficiency is a protective factor for school difficulties,
behavioral and mood impairments.
Methods: 75 children with NC who met the Third International
Classification of Sleep Disorders (median 11,5 years old and diagno-
sis delay of 1,5 years; 57% of boys; 83% of cataplexies; 100% of HLA
+; 17% of obesity; 66% treated by modafinil or methylphenidate)
and 58 controls (median 10.5 years old; 63% of boys) underwent a
one-­night polysomnography, an evaluation of intelligence quotient
(IQ) using the Wechsler Intelligence Scale for Children (WISC IV),
and filled standardized questionnaires of mood, sleep and attention
ABSTRACTS
disorders. The two groups were then subdivided into two-­subgroups
according to their WISC scores (IQ ≤ or ≥ 130): 28 children with NC
with a high potential (HP), 47 children with NC without HP, 32 con-
trols with HP and 26 controls without HP. Four-­groups comparisons
were realized using Chi2 and Kruskal-­Wallis tests. Then, pairwise
comparisons were performed using Fisher's exact and Wilcoxon
tests.
Results: A high prevalence of HP was found in children with NC (37%
vs 2.3% in the general pediatric population). Children with NC with
HP have a higher socio-­economic level (p = 0.03), less difficulties at
school (p = 0.001), and a lower desaturation index (p < 0.001) than
children with NC without HP. No difference was found for other pa-
rameters such as BMI and obesity rate between these two groups.
Children with NC with HP had a lower perceptual reasoning index
(PRI), higher sleepiness scores (p < 0.001) and less conduct (p = 0.01),
learning (p = 0.01) and impulsivity (0.03) disorders than children with
HP without NC. Compared to controls without HP, children with NC
with and without HP and controls with HP had a higher percentage
of REM sleep (p = 0.003).
Conclusions: These results opened the discussion about the rela-
tionship between REM sleep and intellectual efficiency. This study
highlighted the necessity of using neuropsychological parameters in
order to adapt support and to offer a better quality of life to these
children.
Disclosure: Nothing to disclose.
P514 | NARCOCAST: study of prevalence of
narcolepsy in Castellón province (Spain)
1 1
R. Grande González ; J.J. Ortega Albás ; A. Martínez
Martínez2; S. Carratalá Monfort1; J.R. Díaz Gómez2; L. Albiol
Varella3; R. López García1; M. Badenes Lengua1; Á. Montero
Sánchez4; J. Llopis Pitarch2; P. Ortega Gabas1; C. Andreu
Mateu5
1
Unidad de Sueño, Servicio de Neurofisiología Clínica, Hospital General
2
Universitario de Castellón; Unidad de Sueño, Servicio de Neumología,
3
Hospital General Universitario de Castellón; Unidad de Sueño, Servicio
de Otorrinolaringología, Hospital General Universitario de Castellón;
4
Servicio de Neurofisiología Clínica, Hospital General Universitario
de Castellón; 5Servicio de Documentación Clínica, Hospital General
Universitario de Castellón, Castellón de la Plana, Spain
Objectives/Introduction: Narcolepsy is a neurological disorder char-
acterized by excessive daytime sleepiness with related symptoms of
rapid eye movement (REM) and sleep dysregulation. It is considered
a rare neurological disorder, with an estimated overall prevalence
between 15 and 70 cases per 100.000 people. We aimed to esti-
mate the prevalence of narcolepsy by identifying all diagnosed sub-
jects (Narcolepsy type I and type 2) during 2019, in order to better
understand the narcoleptic population of the province of Castellón;
|
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A Mediterranean mid-­eastern region of Valencia community (Spain)
with a population of 571.601.
Methods: We identified patients diagnosed, or monitored by the
province reference unit, the ‘Sleep Unit of the General University
Hospital of Castellón (HGUCS)’. In a second phase, we searched pa-
tients with narcolepsy diagnosis in a clinical database of the primary
health-­care system, SIA (Outpatient information system). Clinical
files were reviewed one by one, each narcolepsy diagnosis was
validated by a somnologist and classified according to the Brighton
Collaboration case definitions.
Results: We found one hundred and fifty-­five patients with a vali-
dated diagnosis of narcolepsy (Male: 68 %; mean age: 42.89 years,
range: 11–73; 40 % with narcolepsy type 1), including 40 cases in
Brighton, definition level 2, 70 cases in level 3 and 10 cases in level
4a. The overall prevalence for narcolepsy was 21.4 cases per 100
000 inhabitants; 8.4 for narcolepsy type 1 and 13 cases for narco-
lepsy type 2. Four additional narcoleptic patients were identified in
‘Plana baja área’ and ‘Alto Palancia area’ through our clinical data-
base (SIA), belonging to the hospital area of Sagunto (Valencia), in-
creasing the overall prevalence by 3.33 %.
Conclusions: Our results are the first study to assess the prevalence
of narcolepsy in the Castellón province, we found that the estimates
for the province are very similar to worldwide estimates. This study
is the first to provide data regarding the prevalence of narcolepsy in
the Valencia community, and it is the second in Spain with validated
cases.
Disclosure: Nothing to disclose.
P515 | The definition of insomnia in people
with intellectual disabilities: an overview
N. van den Broek1; D. Festen2; I. Tan3; S. Overeem1,4; S.
Pillen1,4
1
Centre for Sleep Medicine, Kempenhaeghe, Heeze; 2Department
of Medical Practice, Intellectual Disability Medicine, Erasmus
Medical Center, Rotterdam; 3Centre for Residential Epilepsy Care,
Kempenhaeghe, Sterksel; 4Department of Electrical Engineering,
University of Technology, Eindhoven, The Netherlands
Objectives/Introduction: The reported prevalence of sleep prob-
lems in people with intellectual disabilities (ID) varies greatly, which
may be due to differences in the used definitions or criteria. This sys-
tematic review studied the applied definition of insomnia in people
with ID in previous research and compared these definitions to the
criteria provided by the ICSD-­3. Furthermore, we explored whether
the ICSD-­3 criteria are applicable in people with ID and formulate
key aspects for a definition which may be used in clinical practice as
well as research.
Methods: A literature search was performed in PubMed, EMBASE
and Web of Science. Applied definitions and criteria for insomnia
were extracted and compared to the ICSD-­3.
 |
318 of 356       ABSTRACTS
Results: The initial search yielded 589 articles, of which 10 turned
out to be relevant for the study. The terminology with respect to in-
somnia differed amongst the various studies. Moreover, no uniform
definitions or criteria were used. Cut off points to determine abnor-
mal sleep onset latency, wakefulness after sleep onset, waking early
or sleep efficiency varied widely or were not used at all. Insomnia
complaints were mostly described as nighttime problems; only a mi-
nority of studies included daytime consequences in the definition.
Conclusions: Sleep problems in people with ID are, in the literature,
most often referred to as problematic initiating or maintaining sleep,
or early waking. These problems seemingly address insomnia, but
for example forego daytime impairments as part of the clinical pic-
ture. To recognize insomnia in people with ID and establish reliable
prevalence estimates, a precise definition is important. Key aspects
in such a definition should be the combination of nightly complaints
with daytime consequences. Important is to describe how these
symptoms can manifest differently in people with ID. Also, some
people with ID might experience difficulties communicating com-
plaints themselves and rely on their carers to recognize symptoms. A
clear definition can be helpful there as well.
Disclosure: Nothing to disclose.
P516 | Does the protocol solve all the
problems? How to address the individual needs
of patients in the 8-­week Cognitive Behavioural
Therapy of Insomnia programme
J. Salbert; M. Kłosińska-Rogacka; A. Wichniak
Sleep Medicine Center, Institute of Psychiatry and Neurology in
Warsaw, Warsaw, Poland
Objectives/Introduction: Cognitive Behavioral Therapy of Insomnia
(CBTI) is a structured programme, which includes several therapeu-
tic strategies such as sleep education, stimulus control, sleep restric-
tion, sleep hygiene, cognitive thoughts restructuring and relaxation
training. Findings indicate that, alone or in combination with phar-
macotherapy, CBTI is a highly effective intervention (Jacobs et al.
2004).
Despite the high effectiveness of the treatment, we look for ways
in our clinical work to treat even better by overcoming arising ob-
stacles. Common challenges include lack of reduction in insomnia-­
related worry (Sunnhed et al. 2014), low reduction of dysfunctional
beliefs about sleep (Edinger et al. 2001), general lack of interest in
the therapy (Jacobs et al. 2004).
One of the primary ideas to increase the treatment effectiveness is
to support the standard programme by CBT third wave interventions
(Ong et al. 2012). Precise formulation of an individual's insomnia pro-
file, comprising insomnia duration, comorbid disorders, personality
traits and resulting from the above mentioned specific needs to be
included in the treatment process is also of great importance.
Methods: In this poster we present the results of our therapy work
by describing three case studies in which patients and therapists
faced difficulties with the CBTI interventions due to patient's (a)
dual diagnosis (anxiety disorders symptoms), (b) passive – aggressive
behaviours and (c)long-­time suffering from insomnia and the history
of prior treatment. To overpass these challenges we have tried to
integrate into the regular CBTI protocol elements of motivational in-
terviewing, ACT and schema therapy.
Results: While running the groups we observed what interven-
tions going beyond the regular CBTI protocol could help to sustain
therapeutic relationship with the patients and reinforce the change.
During the 8 week CBTI programme, we followed the regular CBTI
protocol and supported it by motivational interviewing as well as
ACT and schema therapy interventions.
Conclusions: We argue that while running the CBTI group it is im-
portant to keep a balance between strictly following the protocol
and gently adjusting the interventions to the individual needs of
the patients. Adding motivational interviewing, ACT and schema
therapy interventions into the CBTI helps maintain the therapeutic
relationship and reinforces the therapeutic process.
Disclosure: Nothing to disclose.
P517 | Changes of objective and subjective
sleep discrepancy during and after the cognitive
behavioural therapy for insomnia
K. Janků1,2; M. Šmotek1,2; E. Fárková1,2; J. Kopřivová1,2
1
National Institute of Mental Health, Klecany; 2Third Faculty of
Medicine, Charles University in Prague, Prague, Czech Republic
Objectives/Introduction: A subjective and objective sleep discrep-
ancy is often present in patients with insomnia. However, its role and
change during treatment remain unclear. The present study aimed to
assess the effect of cognitive behavioural therapy for insomnia (CBT-­
I) on subjective and objective sleep discrepancy of total sleep time
(TST), sleep onset latency (SOL) and wake after sleep onset (WASO).
The TST discrepancy was assessed across the entire therapy. The
second aim was to examine the treatment outcome of two insomnia
groups differing in sleep perception.
Methods: Thirty-­six adults with insomnia (mean age = 46.7, SD = 13.9;
22 females) were enrolled in the final analyses. Patients underwent
a 6-­week group CBT-­I programme. Sleep diary and actigraphy meas-
urements were obtained during the therapy. Misperception index
(MI = [objective TST − self-­reported TST]/objective TST) was com-
puted to differentiate patients who underestimated TST (n = 16; UN
group) and patients who accurately perceived or overestimated TST
(n = 20; A/O group).
Results: After CBT-­
I, a significant decrease of TST (T = 6.95,
p = 0.000, d = 1.16) and SOL (T = 199.50, p = 0.039, d = 0.47) dis-
crepancy was observed without a change in the WASO discrepancy
in the total sample. Only the UN group reported a decrease in SOL
ABSTRACTS
discrepancy after the treatment, whereas TST discrepancy signifi-
cantly changed in both UN and A/O groups. The UN group showed a
significant decrease in MI TST from Week 1 (0.14 ± 0.08) to Week 2
(0.02 ± 0.15; p = 0.048) when the sleep restriction was implemented,
whereas the A/O group showed the first significant change at Week
4. The latter group tended to overestimate TST after the treatment.
Conclusions: CBT-­I was associated with a reduction of sleep discrep-
ancies. Both groups differing in sleep perception responded similarly
to CBT-­I, although different CBT-­I components could have a more
significant effect in each group. Patients with insomnia who overes-
timate sleep quantity should be taken into account by future stud-
ies to explore whether the treatment effect is associated with more
subtle objective sleep changes, or whether cognitive processes play
a more important role in this group.
Disclosure: Nothing to disclose.
P518 | Feasibility of a personalized and
contextual mobile intervention for Insomnia
M. Cohen-Zion1,2; G. Pillar3,4; L. Glasner2,5; T. Etzioni3,4; A.
Schwartz6,7,8
1
School of Behavioral Sciences, The Academic College of Tel Aviv-­
Jaffa, Tel Aviv-­Jaffa; 2Dayzz Live Well, Ltd, Herzeliya; 3School of
4 5
Medicine, Technion; Carmel Medical Center, Haifa; Sheba Medical
Center, Ramat Gan, Israel; 6Johns Hopkins Sleep Disorders Center;
7
Johns Hopkins Center for Interdisciplinary Sleep Research and
Education, Baltimore, MD; 8Perelman School of Medicine, University of
Pennsylvania, Philadelphia, PA, United States
Objectives/Introduction: Insomnia, the most prevalent sleep dis-
order, has consistently been shown to respond best to cognitive-­
behavioral therapies (CBT-­I). However, due to a lack of professional
expertise, geographic availability and cost of CBT-­I, traditional face-­
to-­face treatments are not accessible to most who suffer from the
condition. However, modern technology may be leveraged to make
digital CBT-­I scalable. The objective of this study was to assess the
feasibility of a CBT-­based mobile intervention for Insomnia, using a
personalized and contextualized engagement engine.
Methods: Participants enrolled were physician-­referred outpatients
between the ages of 18 and 75 years presenting for evaluation of
sleep difficulties at the Sleep Disorders Clinic at the Carmel Medical
Center, Haifa, Israel. Individuals diagnosed with Insomnia were
offered the opportunity to participate in the study. Participants
downloaded the Dayzz Insomnia App onto their smartphones and
commenced with the onboarding process, answered sleep assess-
ment questions, provided nightly sleep diaries and daily outcomes,
and followed the treatment recommendations. Self-­report meas-
ures, including the Insomnia Severity Index (ISI), Glasgow Sleep
Impact Index (GSII) and the WHO-­5, were administered at baseline
and post-­interventions (12 weeks).
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Results: The average age of the sample (n = 26) was 42.5 years
(±15.5), 13 (50%) female, with a mean BMI of 24.8 (±4.5). On av-
erage, participants reported drinking alcohol prior to bedtime 1.0
(±1.7) nights/month, smoking cigarettes prior to bedtime on 2.3
(±7.5) nights/month, taking 6.7 (±11.2) prescription sleeping pills
and 5.2 (±9.7) OTC medications for sleep per month. They also re-
ported napping on average 3.6 (±6.3) times/month. Paired samples
t-­tests show significantly reduced ISI scores from baseline to post-­
treatment (17.8 ± 3.7 vs. 13.5 ± 4.7; t 25 = 4.2, p < 0.001). Significantly
improved quality of life (QOL) was found on two (t 25 = 3.6, p < 0.001
and t 25 = 3.4, p < 0.01) of three (t 25 = 2.0, p < 0.06) GSII subscales. No
differences were found on the WHO-­5 scale (p = ns).
Conclusions: Participants who engaged with the Dayzz App
showed clinically significant improvements in insomnia severity and
insomnia-­related QOL. Our findings suggest that a CBT-­I interven-
tion presented via a mobile platform is a feasible means of treating
insomnia. Future RCT trials are ongoing to evaluate the efficacy and
compliance with the Dayzz digital program.
Disclosure: Dayzz Live Well Ltd (Herzeliya, Israel) provided a grant
and fees to Dr. Cohen-­Zion, Prof. Pillar, and Prof. Schwartz to sup-
port this study.
P519 | The efficacy of Cognitive-­Behavioral
Therapy for Insomnia (CBT-­I) is not predicted by
objective sleep duration
A. Galbiati1; M. Sforza1; C. Leitner1; A. Filice1; F. Casoni2; M.
Zucconi2; M. Manconi3; L. Ferini Strambi1; V. Castronovo2
1
Faculty of Psychology, ‘Vita-­Salute’ San Raffaele University, Milan,
Italy; 2IRCCS San Raffaele Scientific Institute, Department of Clinical
Neurosciences, Neurology – Sleep Disorders Center, Milan, Italy, Milan,
Italy; 3Sleep and Epilepsy Center, Neurocenter of Southern Switzerland,
Civic Hospital of Lugano (EOC), Via Tesserete 46, Lugano, CH-­6903,
Switzerland, Lugano, Switzerland
Objectives/Introduction: Recent studies investigated the role of
objective sleep parameters for predicting the response to Cognitive
Behavioral Therapy for Insomnia (CBT-­
I). In particular, objective
Total Sleep Time (TST) was evaluated to differentiate two ID phe-
notypes: Normal Sleepers (objective sleep duration ≥ 6 hours) and
Short Sleepers (objective sleep duration < 6 hours). The aim of this
study was to evaluate if Normal Sleeper and Short Sleeper, identi-
fied by both Polysomnography and Actigraphy TST, have a different
response to CBT-­I.
Methods: 53 chronic ID patients (females = 50.9%; mean
age = 56.5 ± 11.4) were divided into ‘Normal Sleeper’ and ‘Short
Sleeper’ groups on the basis of actigraphic and polysomnographic
TST. All patients underwent 7-­sessions group CBT-­I. The main clini-
cal outcome was Insomnia Severity Index (ISI) score; secondary
outcomes were Sleep Efficacy (SE), Sleep Latency (SL), Wake After
 |
320 of 356       ABSTRACTS
Sleep Onset (WASO), Number of Awakenings (N°awk) evaluated by
means of sleep diaries.
Results: All ID patients showed significant improvements after
treatment for all clinical outcomes (Sig. p < 0.05). Nevertheless, both
using polysomnography and actigraphy, no significant differences
between ‘Short Sleeper’ (SS) and ‘Normal Sleeper’ (NS) groups were
found in terms of ISI, SE, SL, WASO and N°awk. Furthermore, the
accordance between actigraphy and polysomnography was poor for
the identification of the two subgroups.
Conclusions: These findings suggest a poor reliability of objective
TST measured both with polysomnography and actigraphy in pre-
dicting CBT-­I effectiveness. Moreover, only a small percentage of
patients were classified as short or normal sleepers according to
both polysomnography and actigraphy, pointing out the instability
of these measures. Our results underline the instability and poor re-
liability of objective TST for subtyping ID and for predicting CBT-­I
efficacy.
Disclosure: Nothing to disclose.
P520 | Daytime napping behaviour and
hyperarousal in athletes
R. Pereira; I. Hartescu; R.C. Jackson; K. Morgan
School of Sport Exercise and Health Sciences, Loughborough University,
Loughborough, United Kingdom
Objectives/Introduction: Daytime napping is common among high-­
performance athletes, and is widely assumed to result from sports-­
related sleep debt. However, recent evidence that some athletes are
able to nap ‘on demand’ suggests that the management of daytime
arousal (or hyperarousal) may complement, or even supersede ho-
meostatic pressure as the key factor mediating athlete naps. The
present study, therefore, was designed to explore the nap behaviour
of high-­performance athletes in relation to sleep quality, sleep dura-
tion, and pre-­sleep arousal.
Methods: Convenience sampling approaches identified UK athletes
competing at (at least) a regional level. Participants completed an
online questionnaire comprising assessments of: sleep history suf-
ficient to categorise those meeting DSM-­
5 criteria for insomnia
disorder; daytime napping typology (frequency and duration); sleep
quality (PSQI); sleep reactivity (FIRST); and the Pre-­Sleep Arousal
Scale (PSAS).
Results: Overall, 109 athletes (60 female) completed the question-
naire. The mean PSQI score was 6.2 (SD = 2.6), with 23.9% meet-
ing symptom severity and duration criteria for DSM-­
5 insomnia
disorder. Pre-­sleep cognitive arousal was significantly higher among
athletes with insomnia disorder compared to athletes without in-
somnia (U < 0.0001). Daytime napping was reported by 51% of
athletes. In t-­tests comparing nappers and non-­nappers, napping
was unrelated to PSQI scores (nappers = 6.3 vs non-­nappers = 6.1;
p = 0.77) and subjective total sleep time (nappers = 450 min vs
non-­nappers = 454.8 min; p = 0.75). Chi-­square analyses showed
that reported napping (yes/no) was significantly related to levels of
cognitive arousal, with higher arousal associated with non-­napping
(chi-­square = 4.22, p  = 0.04). Finally, in a multiple regression model,
higher PSAS scores (ß = 1.12; p = 03), FIRST scores (ß = 5.79; p = 01),
and lower TST (ß = 0.98; p = 01) predicted higher PSQI scores.
Conclusions: Napping among high performance athletes is not ad-
equately explained by homeostatic sleep pressure arising from sleep
debt, since nappers and non-­nappers show a similar quantity and
quality of sleep. Rather, the construct of cognitive arousal, and the
related construct of sleep reactivity, appear to play an important role
in both the likelihood of napping, and the achievement of optimal
sleep quality. These results suggest that the mediating role of hy-
perarousal in athlete sleep merits further investigation.
Disclosure: Nothing to disclose.
P521 | Effects of myofunctional therapy (App
AirwayGym®) in the patient with sleep apnea
hypopnea syndrome and simple snoring
L. Rodríguez-Alcalá1; J. Martín-Lagos Martínez1; C.
Rodríguez Alcalá2; J. Parejo Santaella3; B. Rodríguez Gil4; R.
Ríos Fernández5; J.L. Vargas Fernández1
1
Otorrinolaringología, Hospital Universitario Clínico San Cecilio,
Granada; 2Anestesiología y Reanimación, Hospital Universitario La Paz,
Madrid; 3Radiodiagnóstico, Hospital Universitario Virgen de las Nieves,
Granada; 4Anestesiología y Reanimación, Hospital Quiron Salud
Marbella, Marbella; 5Medicina Interna, Hospital Universitario Clínico
San Cecilio, Granada, Spain
Objectives/Introduction: During wakefulness, reflex activation of
the dilator muscles prevents pharyngeal collapse and maintains ad-
equate airway patency. (1). During sleep, these protection mecha-
nisms are altered (2). From the pioneering studies of Remmers et al.
(3), it is believed that the forces that prevent pharyngeal obstruction
are mainly produced by the dilator muscles of the upper airways.
In a recent study by Guilleminault al. (4) it is concluded that the dis-
tinction of obstructive respiratory sleep disorders between children
and adults may not be relevant since the same patterns of lingual
apraxia exist. This would allow to detect an abnormal functioning of
the tongue in the oral cavity in early stages.
Hypothesis: Patients with respiratory sleep disorders present with
lingual steroagnosia, being an early sign of the development of the
disease. The use of oropharyngeal exercises has effects in improving
sleep apneas by increasing the tone of the oropharyngeal muscles.
Methods: We have designed a prospective controlled pilot study
in SAHS patients undergoing CPAP and patients with simple snor-
ing. (n = 30) Evaluating the following changes obtained in the con-
trol group (n = 30) and in the experimental group: Presence or not
of lingual steroagnosia by means of the figure test. The initial and
final polygraphy (IAH, Desaturation Index, Saturation of 02 lower).
ABSTRACTS
Assessment in initial and final visit of the sleepiness questionnaires
Measurement with the IOPI instrument of the muscle tone of the
genioglossus and buccinator muscles before the start of the study
and at the end of the study.
Results: The results show significant differences in the presence
of lingual steroagnosia in patients with obstructive sleep problems
(p = 0.001). The subgroup of patients with OSAHS and simple snor-
ing significantly improved muscle tone after performing oropharyn-
geal exercises (p < 0.05). This is correlated with an improvement in
the polygraphy values, pre/post treatment IOPI, sleepiness ques-
tionnaires, figure test, and adherence to the use of CPAP.
Conclusions: The presence of steroagnosia is a constant pattern in
people with obstructive sleep disorders. Its knowledge may be a
short-­long term indicator of development of this disease, so we con-
sider that myofunctional therapy should be an adjuvant treatment in
these patients.
Disclosure: Nothing to disclose.
P522 | Science communication as a successful
strategy for sleep awareness
A.T. Barros-Viegas1,2,3; L. Gaspar1,2,3; B. Santos1,2; C.
Carvalhas-Almeida1,2; R. Lopes1,2,4; A. Santos-Carvalho1,2,3;
J. Cardoso1,2,3; S. Varela Amaral1,2,3; M.H. Estevão5; J.
Moita5; C. Cavadas1,2,3; A.R. Álvaro1,2,3; Neuroendocrinology
and Aging Group1
1
Center for Neuroscience and Cell Biology, University of Coimbra;
2 Objectives/Introduction: Obstructive Sleep Apnea Syndrome (OSAS)
Center for Innovation in Biomedicine and Biotechnology (CIBB),
University of Coimbra; 3Institute for Interdisciplinary Research (IIIUC),
4 Acromegaly is very low, making its diagnosis challenging and leading to
University of Coimbra; Faculty of Pharmacy, University of Coimbra,
5 the progressive installation of skeletal facial deformities, pharyngeal
Coimbra, Portugal; APS – Portuguese Sleep Association, Coimbra,
Portugal
Objectives/Introduction: We should all spend about a third of
our lives sleeping. But does that happen? Sleep dysregulation is a
scourge in contemporary society. Artificial light, jet leg and stress
are some of the factors that lead to the deregulation of sleep. In
Portugal, population sleeps an average of 6.6 hours and is the soci-
ety that sleeps later in the world. Over 60% of Portuguese people
have sleep problems. Thus, it is urgent to alert the population to the
importance of sleep and the creation of good sleep hygiene habits.
Methods: In collaboration with the Portuguese Sleep Association
(APS), we designed a strategy to raise awareness of Portuguese so-
ciety through informal education. We developed several materials
(brochures, cartoons, board games, infographics and animations)
adapted to different age groups and we promoted and distributed
them in streets, parks, public transportations, science events and
television. Special attention was given to schools in the local com-
munity (district of Coimbra), due to the need to raise awareness
among the younger population about the excessive use of technol-
ogy at night. This year, to mark World Sleep Day, at a time where we
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face a pandemic, our campaign was promoted without direct contact
with population. Infographics were disseminated through more than
900 ATM machines, street digital screens, and outdoors all over the
country for 8 days. The animation video was disseminated trough
social platforms, and also at secretarial and medical posts of the City
Council of Coimbra.
Results: These activities already allowed us to directly reach more
than 500 people and more than 14.200.000 contacts through digital
platforms. It should also be highlighted that there was an increase
in requests to address the topic in schools, which reinforces its rel-
evance for young people.
Conclusions: Science communication revealed to be an effective
way to address the relevance of sleep. In the future, and in order
increase awareness among a larger number of people, we intend to
implement other awareness strategies that allow us to contribute
to improving the national scenario increasing scientific culture and
health literacy in Portugal.
Disclosure: Nothing to disclose.
P523 | Acromegaly: a rare factor in (so
common) Obstructive Sleep Apnea Syndrome
A.P. Craveiro1; M. Baptista2; D. Rocha3; J. Barata4
1
Centro Hospitalar Universitário Cova da Beira; 2CHUCB, Covilha;
3
Centro Hospitalar Cova da Beira, CHCB; 4Covilhã, Covilhã, Portugal
is a highly prevalent medical condition. On contrary, the prevalence of
and tongue changes, enlargement of the extremities of the limbs…
60% of patients with Acromegaly develop OSAS, and the effective
treatment of the 1st condition can improve the 2nd.
Methods: We present two clinical cases illustrating the complex as-
sociation between these two conditions.
Results: Case 1) Female, 62 years old, treated with Auto-­
CPAP
4–14 cmH2O for severe OSAS (RDI 43/h), with good adherence and
clinically stabilized. As comorbidities: Arterial Hypertension (HTA),
Type 2 diabetes mellitus and Depressive Disorder. Due to complaints
of easy tiredness, diffuse swelling of the toes, progressive increase
in the size of the feet (implying a change of footwear) and the no-
tion of deformity of the facial bones (making it difficult to use a
dental prosthesis), an etiological study was started and was found
high serum levels of Somatomedin (IGF-­1) and Growth Hormone
(GH). Subsequently, she performed Computed Tomography (CT)
and Magnetic Resonance (MR) Cranioencephalic (CE), identifying
a pituitary adenoma. Underwent transnasal resection of the lesion
and, 2 years after surgery, she developed regression of the clinical
stigmas of the disease. Polysomnography was repeated, which was
compatible with moderate OSAS (RDI 17/h).
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322 of 356       ABSTRACTS
Case 2) Male, 67 years old, diagnosed with severe OSAS (RDI 43/h),
being treated with Auto-­
CPAP 4–14 cmH2O. As comorbidities:
Bronchial Asthma and HTA. Due to anatomical changes in the jaw,
edema of the hands and feet, complaints of headache and easy tired-
ness, the serum determination of GH and IGF-­1 was carried out, which
were greatly increased. After CT and MRI-­CE, a pituitary macroade-
noma was identified. Transnasal resection of the lesion was performed,
with clear improvement in the edema of the hands and face, but with-
out repercussions in terms of Sleep Respiratory Pathology.
Conclusions: It has long been recognized that the pathophysiology
of OSAS involves the interaction of multiple and complex factors.
The etiological study, and a targeted approach, of certain pheno-
types may be the key to therapeutic success in some cases.
Disclosure: Nothing to disclose.
P524 | Evaluate the prevalence and specificity
of sleep disorders in children aged 2–18 years
with type 1 diabetes referred to endocrinology
clinic in Iran 2018–2019
F. Saffari; S. Jalilolghadr
Children Growth Research Center, Research Institute for Prevention of
Non-­Communicable Diseases, Qazvin University of Medical Sciences,
Qazvin, Islamic Republic of Iran
Objectives/Introduction: Sleep and rest are important components
of human life and insomnia has a two-­way relationship with the
prevalence and incidence of diabetes. Sometimes insomnia can be
secondary to diabetes or it can be a trigger for diabetes. This study
was designed to evaluate the prevalence and specificity of sleep dis-
orders in children aged 2–18 years with type 1 diabetes referred to
endocrinology clinic and hospital clinic in 2018–2019.
Methods: This is a descriptive-­analytical study in which 47 type 1
diabetes children (23 girls and 24 boys) participated. CSHQ ques-
tionnaire was filled out by their parents and compared with age and
sex matched control group. Data were analyzed by SPSS software.
Results: 78.7% of diabetic children had sleep disorder. Overall score
of sleep disorder in diabetic patients was significantly higher than
control group. But there was no significant relationship with age,
sex, BMI and HbA1C elevation.
Conclusions: Since the prevalence of sleep disorder in diabetic
children is higher, timely diagnosis can prevent their progression
complication.
Disclosure: Nothing to disclose.
P525 | Sleep quality in health workers exposed
to the COVID-­19 pandemic
A. Herrero San Martin1; J. Parra Serrano1; T. Diaz
Cambriles2; E. Arias Arias2; J. Muñoz Méndez2; M.J. del
Yerro Älvarez3; M. González Sánchez1
1
Neurology; 2Neumology; 3Psychiatry, Hospital 12 de Octubre,
Madrid, Spain
Objectives/Introduction: The Coronavirus disease 2019 (COVID-­19)
outbreak caused by the new coronavirus SARS-­CoV-­2 has caused
a huge impact on our environment, with consequences to be de-
termined. Health workers have been placed under enormous care
pressure and potential traumatic exposure, that might have conse-
quences on their health, specifically in their quality of sleep. In this
line, we try to assess sleep quality and the development of sleep
disorders in health personnel directly involved in care of COVID-­19
patients at the height of the pandemic, compared to non-­healthcare
workers.
Methods: A cross-­sectional, anonymized, self-­reported question-
naire survey was carried out at the ‘12 de Octubre’ Hospital, in
Madrid, Spain, during the outbreak of COVID-­19, from March 1th
to April 30th 2020. We compared two groups, healthcare workers
who have treated directly COVID-­19 patients versus non-­healthcare
workers. The questionnaire included demographic data, sleep re-
lated aspects, Epworth Sleepiness Scale (ESS), Pittsburgh Sleep
Quality Index, (PSQI), Insomnia Severity Index (ISI) and 17-­items
Hamilton Rating Scale (HRS).
Results: Overall, 170 participants completed the questionnaire suc-
cessfully, 100 healthcare workers and 70 non-­healthcare workers.
Self-­reported insomnia, nightmares, sleepwalking, sleep terrors and
PSQI > 6 were more frequent in the healthcare group (p < 0.05). Shift
work was associated to greater risk when performing multiple logis-
tic regression analysis
Conclusions: In this study, healthcare workers directly involved
in the treatment or attention to COVID-­
19 patients during the
COVID-­19 pandemic showed a higher incidence of insomnia self-­
reported symptoms, when compared to non-­healthcare workers.
Besides, we observed that healthcare workers on the front line de-
veloped more sleep disturbances than non-­healthcare professionals,
and they had worse quality of sleep. Special attention should be paid
to shift workers. Concrete protection and prevention measures for
particularly exposed population should be considered in pandemic
situations.
Disclosure: Nothing to disclose.
ABSTRACTS
P526 | The impact of COVID-­19 pandemic on
sleep quality
M. Ntafouli; D. Dikeos
Sleep Research Unit, First Department of Psychiatry, National and
Kapodistrian University of Athens, Athens, Greece
Objectives/Introduction: The COVID-­
19 pandemic (declared as
such by the World Health Organization on March 11, 2020) is a
major public health crisis affecting several nations around the world.
The COVID-­19 outbreak has already affected many lives all over the
world, having an impact on people's mental health not only due to
the anxiety about the disease itself, but also as a consequence of the
significant disruption of living and social habits resulting from lock-
down measures taken by various governments around the world.
The lockdown measures in Greece have been wide restrictive and in
its majority the population complied with them.
The aim of this study is to investigate sleep disturbances in the Greek
population during the period of the lockdown.
Methods: An online survey was conducted, through which 1.275
participants of the Greek general population where recruited. The
survey was advertised on the Internet and through social media
and various networks. The Athens Insomnia Scale (AIS) was utilized,
alongside with a questionnaire on sleep habits and various socio-­
demographic characteristics.
Results: The majority of the participants were females (70.7%) and
most of them lived in Athens. About 12% complained of insomnia,
while about 2/3 reported that their sleep schedule was phase-­
delayed during the lockdown. The analysis is ongoing and more re-
sults will be presented.
Conclusions: The COVID-­19 pandemic and its consequences seem
to affect sleep quality and the sleep-­wake cycle of the population.
Disclosure: Nothing to disclose.
P527 | Cognitive behavioural therapy for
insomnia (CBT-­I) conducted by video call
communication during home confinement due to
the COVID-­19 outbreak
J. Adrien1; A. Labonne2; D. Leger2,3
1
Equipe VIFASOM, Université Paris-­Descartes, Centre du Sommeil et
2
de la Vigilance, Hôtel-­Dieu de Paris-­Aphp; Centre du Sommeil et de la
Vigilance, Hotel-­Dieu de Paris; 3Centre du Sommeil et de la Vigilance-­
Equipe VIFASOM, Paris, France
Objectives/Introduction: Cognitive behavioural therapy for insom-
nia (CBT-­
I) is currently delivered in group sessions to insomniac
outpatients of the Hotel-­Dieu sleep disorder clinic. With the home
confinement due to the COVID-­19 outbreak, we have adapted our
group face-­
to-­
face protocol to group visioconferencing sessions
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(eCBT-­I). We show in the present work the feasibility and clinical ef-
ficacy of such protocol.
Methods: 37 patients (32 women, 5 men; 50.0 ± 2.3 yrs) with
chronic insomnia received a classical CBT-­I (behavioural, educational
and cognitive components) delivered by video call communication
(skype) in groups of 4–6 patients (eCBT-­I group). Each session com-
prised firstly a 15–30 min part for assessing the sleep diaries, and
secondly 20–30 min for watching a home-­made video educational
programme specific to the session. Finally, a 10–20 min time was
allowed for delivering the instructions and for questions, comments
and discussion.
Outcome measures (ISI, BDI-­
II, BAI scores, as well as sleep pa-
rameters) were assessed before and after treatment, and then at
2 months follow-­up. Results are compared to those in 37 paired pa-
tients that followed the same group protocol but face-­to-­face at the
sleep clinic before the confinement (PRES). Statistical significancy
was set at p < 0.05.
Results: Among the 37 patients of the eCBT-­I group, 17 have pres-
ently completed the 6 sessions and 20 have received 5 sessions. The
insomnia severity index (ISI) was significantly reduced after 6 weeks
of treatment (17.5 ± 0.8 to 11.1 ± 1.2), as well as the Beck depression
and anxiety indices (BDI-­II: 14.2 ± 1.7 to 7.7 ± 1.4; BAI: 10.7 ± 1.9
to 7.5 ± 1.2). Concomitantly, all sleep diary parameters (sleep onset
latency, sleep efficiency, wake after sleep onset) were improved.
These preliminary data are the same as those obtained in the 37
PRES patients.
To date, the study is still ongoing and complete results including
the 2 months follow-­up assessment will be obtained at the end of
August and presented at the congress.
Conclusions: Group sessions of eCBT-­I benefit to insomniac patients
with the same clinical efficacy as that of face-­to-­face group sessions.
This might be interesting for dissemination of the CBT-­I at a large
scale with a reduced cost, notably in France where CBT-­I is poorly
developed.
Disclosure: Nothing to disclose.
P528 | Acceptance, feasibility and
effectiveness of a sleep training for patients
of a psychosomatic rehabilitation clinic – a
randomized controlled study
J. Faber1; I. Steinbrecher-Hocke2; P. Bommersbach2; A.
Schlarb1
1
Bielefeld University, Bielefeld; 2Eifelklinik Manderscheid,
Manderscheid, Germany
Objectives/Introduction: Patients from a psychosomatic rehabilita-
tion clinic suffer from various mental and physical disorders; how-
ever, sleep does not receive as much attention as needed. Yet, 86.6 %
of German patients from psychosomatic rehabilitation clinics report
an impaired sleep quality during admission and almost 70 % during
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324 of 356       ABSTRACTS
discharge. Approximately 62 % even meet the diagnostic criteria for
insomnia. Hence, the aim of this study is to evaluate the acceptance,
feasibility and effectiveness of a sleep training in a German psycho-
somatic rehabilitation clinic.
Methods: All patients were screened for insomnia criteria and an
impaired sleep quality during admission. Eligible patients were al-
located to either the intervention or control group. The interven-
tion group received the treatment as usual and the sleep training
on top over a period of three weeks, whereas the control group re-
ceived solely the standard treatment. The sleep training combines
cognitive-­behavioural and hypnotherapeutical elements. A total of
347 patients with a mean age of 50 years participated in this study
(intervention group: n = 164; control group: n = 183). Various sleep
parameters were assessed using sleep questionnaires, sleep diaries
and actigraphy.
Results: Patients and therapists assessed the sleep training posi-
tively regarding content and implementation. Subjective sleep meas-
ures (Pittsburgh Sleep Quality Index, Insomnia questionnaire) as well
as objectively measured sleep parameters significantly improved in
both groups. However, the intervention group had higher improve-
ments after training on a descriptive level. Sleep diaries data of the
intervention group showed a clinical significant reduction of sleep
latency and improvements of total sleep time and sleep efficiency.
Conclusions: The results demonstrate that sleep is a relevant topic
in psychosomatic rehabilitation clinics. Considering sleep problems
and their treatment might also enhance the effectiveness of the
overall treatment, especially when we focus in relapse rates and
long-­term effects of in-­clinic treatments. Further analyses of sub-
groups are warranted.
Disclosure: This project was financially supported by refonet (reha-
bilitation research network) and the German Pension Insurance for
Rhineland.
P529 | Molecular study of restless legs
syndrome in Iranian families
Z. Alibabaei1; A. Hesampour1; S.M. Hamdi1; B. Alibabaei2
1 2
Biology, Islamic Azad University, Tehran; IT, Islamic Azad University,
Kerman, Islamic Republic of Iran
Objectives/Introduction: Restless Legs Syndrome (RLS) is a com-
mon motor neurological disorder. It occurs with discomfort in the
legs, burning and itching, usually at night and every 10 to 60 sec-
onds. It requires movement and sensation. Unpleasant feet improve
with movement. In 20% of patients, the symptoms can also include
the arm and other parts of the body, which often occur in the more
severe form of the disease. Diagnosis is based on clinical symptoms.
The source of the disorder is still unknown. However, in general,
based on research, this syndrome is a multifactorial or multifactorial
syndrome. Native and environmental or medical factors are divided.
In this study, this disorder was examined genetically and molecularly
and the genes affecting the disease in the Iranian population were
identified by NGS method.
Materials and methods: In this study, NGS and SEQUENCING ex-
amined the relationship between the genes involved in the disease
and the patients.
Methods: In this study, NGS and SEQUENCING examined the rela-
tionship between the genes involved in the disease and the patients.
Results: The results of molecular study of restless legs syndrome
using NGS method led to the identification of new gene locations
on ATXN7 and TANC1 genes in the Iranian population. Genetic sites
on the MEIS1 gene have also been confirmed by previous research
on the involvement of this gene in the development of restless legs
syndrome. I study on 30 sample from F1,F2,F3 of pedigree. We use
SPSS for data analysis.
Conclusions: In this study, it was found that the genes tanc1, atxn7,
meis1 are effective in the development of restless legs syndrome. In
this study, a total of 8 new genetic sites on tanc1 and atxn7 genes
were identified in the Iranian population.
Disclosure: This study will publish as soon as possible after submit
new variants in NCBI.
P530 | Review and meta-­analysis of
pharmacological responsiveness of periodic limb
movements during sleep
S. Riccardi1; R. Ferri2; C. Garbazza3; S. Miano3; M. Manconi3
1
Neurocentro della Svizzera Italiana, Neurocentro della Svizzera
Italiana, Lugano, Switzerland; 2Oasi Research Institute IRCCS, Troina,
Italy; 3Neurocenter of Southern Switzerland, Lugano, Switzerland
Objectives/Introduction: Periodic limb movements during sleep
(PLMS) are a very common finding in general population, but they
are especially associated with Restless Legs Syndrome (RLS). The
clinical burden and consequently the need to treat PLMS are still
matter of discussion. Most of the available drugs have been tested
in RLS and much less in PLMS, however, the efficacy on sensory and
motor component might differ. Herein, we performed a review and
meta-­analysis of the available literature to compare the efficacy of
different drugs on the single PLMS component of RLS.
Methods: We reviewed all papers published up to March 2020, pro-
viding data on PLMS index (mean + SD), recorded by bilateral tibi-
alis electromyography (EMG) , before and after treatment, and with
sample size greater than 5 patients. When possible, we performed a
meta-­analysis, through DerSimonian-­L aird estimator.
Results: The meta-­analysis showed a significant effect size for both
L-­Dopa (−1.05 [C.I. −1.60–0.49]) and miscellaneous dopamine agonists
(DA) (-­1.49 [C.I. −2.23, −0.75]); as pramipexole was the most studied
compound, we could perform a meta-­
analysis on pramipexole ef-
fect alone, with evidence of similar high effect size (−1.37 [C.I. −1.58,
−1.15]). Regarding α2δ-­ligands, the analysis showed a significant overall
ABSTRACTS
effect size of gabapentin (−0.67 [C.I. −1.10, −0.23]) but lower than that
found for L-­Dopa and DA. Opioids also showed a significant overall ef-
fect size, close to that found for L-­dopa (−0.93 [C.I. −1.54, −0.31]). The
meta-­analysis of benzodiazepines showed still an effect size on PLMS
index, with a value lower than all other drug categories (−0.47 [C.I.
−0.89, −0.06]). Other few studies are available on iron, antiepileptics,
other pharmacological treatments, but no meta-­analysis was possible.
Conclusions: Many scientific works don't report objective polysom-
nographic results on PLMS, focusing mainly on sensory RLS symp-
toms. Data on PLMS are scanty or imprecise, or not comparable each
other for lack of uniformity in outcome measures. Across decades,
PLMS scoring have been performed with different criteria. However,
dopaminergic compounds and dopamine agonists are more effective
in suppressing PLMS than other medications.
Disclosure: Nothing to disclose.
P531 | The complex relation between sleep
and motor performance in Parkinson's disease
F. Faraci1; P.-E. Nunes-Ferrreira2; C. Ferlito2; L. Fiorillo1; A.
Mascheroni1; M. Dramé3; A. Puiatti1; A. Kaelin-Lang2;
P.-L. Ratti2,4
1
Department of Innovative Technologies, University of Applied Sciences
and Arts of Southern Switzerland, Manno; 2Neurocenter of Southern
3
Switzerland, Lugano, Switzerland; Methodology for Clinical Research
Unit, University Hospital of Martinique, Fort-­de-­France, Martinique;
4
Department of Neurology, dell'Angelo Hospital, ULSS 3 Serenissima,
Venice, Italy
Objectives/Introduction: A prominent, unpredictable, highly varia-
ble sleep-­dependent amelioration in motor performance is reported
by up to 40% of the patients with Parkinson's Disease (PD) and re-
ferred to as ‘sleep benefit’. We aim to better describe this phenom-
enon and to explore putative sleep parameters accounting for it.
Methods: Twenty-­six mild to moderate idiopathic PD patients (9
females, 67 ± 9.8 year-­old) underwent 2 non-­consecutive full-­night
video-­
polysomnographies. Motor performance was assessed by
clinical examination according to the Movement Disorders Society
Unified Parkinson's Disease Rating Scale motor part (MDS-­UPDRS-­
III) at bedtime and in the morning 30 minutes after awakening. We
defined a positive motor effect of sleep (PMES) as a bedtime-­to-­
morning 10% or greater improvement in the MDS-­UPDRS-­III total
score or in one of its motor factors. The link between sleep features
and PMES was explored by means of Welch two-­sample t-­test and
univariate logistic regression.
Results: No patient showed a 10% improvement in the MDS-­UPDRS-­
III total score. Nevertheless, we noticed a PMES in at least one motor
factor 36 times (67%) during the 2 nights, in 23/26 patients: n = 2 for
axial signs, n = 5 for rest tremor, n = 11 for rigidity, n =  7 for right
hand dexterity, n =  8 for left hand dexterity, n =  5 for postural and
kinetic tremor, n = 18 for lower limbs agility.
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Among the motor factors most frequently showing PMSE, rigid-
ity was linked with shorter total sleep time (p = 0.008; OR 0.983
p = 0.006) and lower N1 sleep time (p = 0.003; OR 0.963 p = 0.022).
PMES on lower limbs agility was connected with lower N1 sleep per-
centage (p = 0.039; OR 0.931 p = 0.067) and more leg movements in
wake (p = 0.045; OR 1.021, p =  0.022).
Conclusions: The influence of sleep on motor performance in PD
does not seem to be an all-­in-­one phenomenon. In fact, some motor
factors – yet not others – appear to be influenced by sleep. Rigidity
and lower limbs agility seems influenced the most by sleep. These
preliminary observations help shedding light on the intriguing and
controversial phenomenon of ‘sleep benefit’ in PD.
Disclosure: Nothing to disclose.
P532 | Changes in midbrain iron deposits in
restless legs syndrome after intravenous iron.
Long-­term neuroimaging and clinical follow-­up
C. Garcia-Malo1; S. Novo Ponte1; C. Miranda2; S. Romero
Peralta2; V. Martinez Vidal2; I. Cano-Pumarega2; S. Boi2; L.
Botta3; S. Anguizola4; D. Garcia-Borreguero2
1
Neurology; 2Sleep Research Institute, Madrid, Spain; 3European Sleep
Institute, Santiago, Chile; 4European Sleep Institute, Panama, Panama
Objectives/Introduction: Previous studies have shown reduced iron
levels in SN in RLS. In the last decade, transcranial sonography (TCS)
has enabled us to quantify these deposits. Moreover, one of the
most effective and safest treatment for RLS is intravenous (IV) iron.
Our objectives were:
• To analyze whether SN echogenity changes as a result of IV iron,
and its evolution during follow-up.
• To analyze clinical benefit from IV iron in RLS in the long-term.
• To analyze whether baseline SN echogenity could predict clinical
outcome after IV iron.
Methods: A prospective observational study was conducted in RLS
patients (>18 years old) going to be treated with IV iron according
to the current guidelines (transferrin saturation < 45%, serum fer-
ritin < 300 mg/ml). TCS was performed at baseline, obtaining in-
formation about SN iron deposits, (variable called substantia nigra
echogenity index-­SNEI). Patients also completed the international
restless legs scale (IRLS) to evaluate the severity of symptoms. SNE
and IRLS were evaluated along follow-­up.
Results: 58 patients were included. They were evaluated at baseline
and 87 ± 35, 194 ± 114 and 279 ± 185 days after receiving IV iron.
The sample was stratified into two groups according to the median
SNEI obtained at baseline: SNEI < 0.1802 cm2 (severely hypoecho-
genic group-­sHE) and SNEI  ≥  0.1802  cm2 (moderately hypoecho-
genic group-­mHE).
A global increased was observed in SNEI in the three follow-­up vis-
its, being this increased greater among those subjects having lower
 |
326 of 356       ABSTRACTS
baseline SNEI (sHE group) + 18.1% sHE vs + 5.2% mHE (p = 0.0142),
+14.56% vs + 9.78% (p = 0.0094) and + 11.83% vs −5.55% (p = 0.1441)
respectively in the follow-­up visits.
Global clinical improvement was observed among two groups, with
a total reduction of −6.41  ±  9.93, −7.5  ±  10.32 and −10.43  ±  8.44
points in IRLS in the 1st, 2nd and 3rd evaluation. No significative dif-
ferences were observed when comparing both groups.
Conclusions: IV iron is effective for treating RLS and it induces
changes in SN iron deposits. These changes are greater among those
subjects with lower baseline iron deposits. A global clinical benefit
is observed for IV iron treatment, lasting during the follow-­up of our
investigation.
Disclosure: Nothing to disclose.
P533 | Correlation of restless legs syndrome
with oxygen saturation: implications for altitude
S. Khachatryan1,2; Z. Tavadyan1,2; J. Ulfberg3
1 Objectives/Introduction: The aim of this study is to enlighten and
Department of Neurology and Neurosurgery, National Institute of
2 3
Health; Somnus Neurology Clinic, Yerevan, Armenia; Circad Health,
Nora, Sweden
Objectives/Introduction: The relationship between restless legs
syndrome (RLS) and altitude is described in several studies and rep-
resents an interesting and intriguing direction for understanding the
nature of this common sleep-­related movement disorder. Armenia is
mostly a mountainous country with variable geography varying from
valleys to mountainous highlands with urban and rural communities
on various altitudes. Our aim was to study the connection between
RLS prevalence depending on altitude and oxygen saturation (OS) in
Armenian population.
Methods: This study was a part of a larger ‘Sleep and its disorders
in Armenia’ door-­to-­door epidemiological study conducted at four
different sites differing by geographic location and altitude (850–
2450 m). Mostly interview-­based, it included also a one-­time OS
measurement in involved subjects by a finger pulseoxymeter. RLS
was diagnosed according to internationally accepted 4 essential clin-
ical diagnostic criteria (IRLSSG). Descriptive, comparison of means,
Pearson's correlation analysis and ANOVA statistics were used.
Results: There was a 1001 subject involved in this study (mean age
– 45.3 (18–88), females-­67.5%). Overall, 15% of the sample had RLS,
which was seen more in females (F/M = 16.7%/11.4%). Its preva-
lence according to the chosen sites is presented from the lowest to
the highest location: 12.8% (305), 14.4% (n = 402), 17% (n = 264),
26.7% (n = 30) (p > 0.05). RLS subjects had lower mean OS than non-­
RLS group (95.8% vs. 96.6%, p < 0.05). There was a moderate nega-
tive correlation between altitude and mean OS in the general sample
(−0.29, p < 0.01). Interestingly, the correlation test showed a higher
negative correlation of mean OS with altitude among RLS subjects (-­
0.423, p < 0.01) compared to non-­RLS participants (-­0.251, p < 0.01).
ANOVA test revealed a clear and significant decrease of mean OS
depending on altitude in both RLS/non-­
RLS groups respectively
(%,p < 0.05): 97.1/97.2, 96.2/96.7, 95.1/95.8, 90.9/94.5, although
RLS group had lower absolute values for all sites.
Conclusions: With the high prevalence of RLS in Armenian popu-
lation we saw a gradient of RLS prevalence increase depending on
altitude. Also, we substantiate the role of oxygen saturation and alti-
tude as important factors in the formation of RLS. Further research
is needed towards a better understanding of this relationship.
Disclosure: Nothing to disclose.
P534 | Prevalence of risk factors in non-­rapid
eyes movement parasomnias in adults
M. Pintor
Clinical Neurophysiology, Hospital Universitario Rey Juan Carlos,
Mostoles, Spain
analyze the prevalence of the most common risk factor in non-­rapid
eyes movement parasomnias (NREM).
Methods: We analyzed retrospectively all patients from January
2017 to December 2019 with NREM parasomnias diagnosed at the
neurologic sleep medicine consultation at Rey Juan Carlos Hospital
(HRJC). We excluded patients below 16 years old.
Results: Our sample had 40 patients, 60% female, the median age
of whom was 35 years old with a standard deviation of 15 years
old. 74% of them stated to have previous episodes in childhood and
52.9% identified 1st and 2nd grade familiars with episodes of com-
patibles with NREM parasomnias.
The most frequent NREM parasomnias type was sleepwalking
(52.5%) followed by confusional arousal (37.5%). The median fre-
quency of the episodes was 3 nights per week. A polysomnographic
record was performed in 52.5% of the patients.
The most prevalent risk factor was stress (76.7%), followed by exces-
sive blue light exposition at night (56.5%), comorbid sleep patholo-
gies like OSA or RLS (46.9%) and working or studying in the hours
previous to sleep (40.7%). Less frequent were chronic sleep priva-
tion (29.7%), intense physical activity in the hours previous to sleep
(17.4%), shift work (15.2%) and irregular sleep schedule (11.4%).
23.3% of them were using psychopharmacological medication (ben-
zodiazepines, antihistaminic, opioids…) and 14.3% referred toxics
consumption.
Conclusions: The most common risk factors in our sample were, in
decreasing order, the stress, excessive blue light exposition at night,
comorbid sleep pathologies and working/studying in the hours pre-
vious to sleep.
Disclosure: Nothing to disclose.
ABSTRACTS
P535 | Hyposmia in patients with isolated REM
sleep behaviour disorder
P. Marrero; A. Iranzo; M. Serradell; C. Gais; J. Santamaria; I.
Vilaseca
Hospital Clinic de Barcelona, Barcelona, Spain
Objectives/Introduction: Hyposmia and isolated REM sleep behavior
disorder (IRBD) are markers of the prodromal phase of Parkinson disease
(PD) and dementia with Lewy bodies (DLB). Our objective is to evaluate
the frequency and implications of hyposmia in patients with IRBD.
Methods: UPSIT-­4 0 was tested in 139 patients with IRBD and 77 sex
and age-­matched controls to assess odor identification. Hyposmia
was defined by an UPSIT score below two standard deviations from
the controls mean.
After a follow up of 5.6 ± 3.9 years, we evaluated whether hyposmia
constitutes a marker of early conversion to PD and DLB and whether
a distinction can be made between conversion to PD or DLB.
Results: Patients were 69.6 ± 6.7 years old when test UPSIT-­40 was
performed. UPSIT-­40 score was lower (worse smell identification) in
patients than in controls (20.1 ± 6.5 vs. 28.6 ± 5.0, p < 0.001). Sixty
(43.2%) patients had hyposmia. By the end of follow-­up, 41 (29.5%)
patients developed PD (n = 27), DLB (n = 13) and multiple system
atrophy (n = 1). Patients with hyposmia were at higher risk of develop-
ing PD and DLB than patients with normosmia (p = 0.012). Hyposmia
in patients with IRBD did not distinguish the development of PD (15
patients with hyposmia and 12 patients with normosmia) or DLB (nine
patients with hyposmia and four patients with normosmia) (p = 0.41).
Conclusions: Hyposmia is frequent in patients with IRBD. Hyposmia
predicts short-­term conversion to PD and DLB, but without distinc-
tion between PD or DLB.
Disclosure: Nothing to disclose.
P536 | Validation of the Chinese version of the
Munich Chronotype Questionnaire in Hong Kong
youths
1 2 1 3 4
F.T.W. Cheung ; A.W.Y. Ho ; X. Li ; J.W.Y. Chan ; J. Zhang ;
N.Y. Chan3; C.S. Ho2; Y.K. Wing3; S.X. Li1,5
1 2
Psychology, The University of Hong Kong; Chemical Pathology;
3
Psychiatry, The Chinese University of Hong Kong, Hong Kong, Hong
4
Kong; Guang Dong Mental Health Center, Guangdong Provincial
People's Hospital, Guangdong Academy of Medical Sciences,
Guangzhou, China; 5The State Key Laboratory of Brain and Cognitive
Sciences, The University of Hong Kong, Hong Kong, Hong Kong
Objectives/Introduction: Chronotype, referred to as individual's diurnal
preference of timing for sleep and activities, can be measured using the
Munich Chronotype Questionnaire (MCTQ). The MCTQ has the advan-
tage over other questionnaires on circadian typology, such as Horne and
|
      327 of 356
Ostberg's Morningness-­Eveningness Questionnaire (MEQ), as it differen-
tiates actual sleep and wake time for workdays and free days and uses the
midpoint of sleep (MSF) as well as its correction for sleep debt (MSFsc) ac-
cumulated over the workdays to estimate chronotype. The current study
aimed to validate the Chinese version of MCTQ in the youth population.
Methods: The original MCTQ was translated into Chinese language
(C-­
MCTQ) using translation-­
back-­
translation method. Youth par-
ticipants completed a battery of self-­report questionnaires online
consisting of the C-­MCTQ and MEQ for the measures of circadian
preference, Insomnia Severity Index (ISI) as a measure of insomnia
symptoms, and Patient Health Questionnaire (PHQ-­9) as a measure
of depressive symptoms. A subset of sample additionally completed
the objective measures of circadian rhythm including actigraphic as-
sessment for seven consecutive days (n = 38) and laboratory-­based
dim-­light melatonin onset assessment (DLMO; n = 17).
Results: A total of 612 participants completed the questionnaire meas-
ures (age: 20.81 ± 2.0 years, range: 16–24; female: 68%). Test-­retest re-
liability for C-­MCTQ was good (intra-­class correlation = 0.67–0.82). All
parameters of MCTQ (i.e. MSF, MSFsc, midpoint of sleep during work-
days [MSW]) were significantly correlated with MEQ score (r  =  -­0.54
to -­0.66). MSFsc was 04:12 ± 1:09, 05:21 ± 1:06 and 06:35 ± 1:14 for
morning-­type, intermediate-­type, and evening-­type based on MEQ, re-
spectively (p < 0.001). All MCTQ parameters showed higher correlations
with actigraphy-­based circadian parameters compared to MEQ. DLMO
showed a significant association with MSF (r = 0.49, p = 0.04), and margin-
ally significant association with MSFsc (r = 0.45, p = 0.069). In addition,
later MSFsc was significantly correlated with higher ISI and PHQ-­9 scores.
Conclusions: The present study demonstrated that the C-­MCTQ
could be used as a good clinical tool to reflect an individual's endog-
enous circadian timing and is suitable for assessing chronotype with
good reliability and validity in Chinese youths.
Disclosure: Nothing to disclose.
P537 | Actigraphy in brain-­injured patients
– a valid measurement for the assessment of
circadian rhythms?
M. Angerer1,2; M. Schabus1,2; M. Raml1; G. Pichler3; A.B.
Kunz4,5; M. Scarpatetti3; E. Trinka2,4; C. Blume2,6,7
1
Laboratory for Sleep, Cognition and Consciousness Research,
Department of Psychology; 2Centre for Cognitive Neuroscience
Salzburg (CCNS), University of Salzburg, Salzburg; 3Apallic Care Unit,
Albert Schweitzer Clinic, Geriatric Health Centres of the City of Graz,
Graz; 4Department of Neurology, Christian Doppler Medical Center,
Paracelsus Medical University; 5Gunther Ladurner Nursing Home,
Salzburg, Austria; 6Centre for Chronobiology, Psychiatric Hospital of
the University of Basel; 7Transfaculty Research Platform Molecular and
Cognitive Neurosciences, University of Basel, Basel, Switzerland
Objectives/Introduction: In the last decades, the measurement of physi-
cal activity, so-­called actigraphy, has received increasing attention in
 |
328 of 356       ABSTRACTS
classifying rest-­activity cycles of healthy individuals. Recently, actigra-
phy was also used for the investigation of day/night patterns and circa-
dian rhythms (i.e. rhythms with a period length of approximately 24 h)
in patients following severe brain injury. As those patients often need
full-­time care, actigraphy measures may be highly influenced by pas-
sive movements, such as nursing activities and therapies. Therefore, we
sought to systematically control for passive movements in this study and
investigate whether circadian rhythmicity is (still) visible in actigraphy
data from patients with DOC after correcting for passive movements.
Methods: Wrist actigraphy was recorded over 7–8 consecutive days
in patients with DOC (diagnosed with unresponsive wakefulness syn-
drome [UWS; n = 19] and [exit] minimally conscious state [MCS/EMCS;
n = 11]). Presence and actions of clinical and research staff as well as
visitors were indicated using a tablet in the patient's room. Following
removal and interpolation of passive movements, non-­parametric rank-­
based tests were computed to identify differences between circadian
parameters of uncorrected and corrected actigraphy data.
Results: Uncorrected actigraphy data overestimated the interdaily sta-
bility (p = 0.003) and intradaily variability (p < 0.001) of patients’ ac-
tivity and underestimated the deviation from a circadian 24 h-­rhythm
(p = 0.001). Only 5/30 (17%) patients deviated more than 1 h from 24 h
in the uncorrected data, whereas this was the case for 17/30 (57%)
patients in the corrected data. When contrasting diagnoses based
on the corrected dataset, stronger circadian rhythms (p = 0.065) and
higher activity levels (day [7 am–11 pm]: p = 0.007; night [11 pm–7 am]:
p = 0.002) were observed in MCS/EMCS as compared to UWS pa-
tients. Day-­to-­night differences in activity were evident for both pa-
tient groups (MCS/EMCS: p = 0.014; UWS: p = 0.026).
Conclusions: Our findings indicate that uncorrected actigraphy data
overestimates the circadian rhythmicity of patients’ activity, as nurs-
ing activities, therapies, and visits by relatives follow a circadian pat-
tern itself. Consequently, actigraphy data needs to be corrected to
allow for meaningful conclusions about circadian rhythms in patients
with DOC, and should be considered carefully; especially with re-
gards to frequent motor impairments, spasticity and the usage of
muscle relaxants in this patient population.
Disclosure: Nothing to disclose.
P538 | Investigating the impact of sleep on
declarative memory consolidation performance
in children with self-­limited focal epilepsy
M. Brichet1,2; A. Peiffer1,2; F. Genicot1; E. Juvene3; S.
Baijot1,3; S. Galer1,3; X. De Tiege2; A. Aeby1,3; C. Urbain1,2
1
UR2NF-­Neuropsychology and Functional Neuroimaging Research
Unit, Université Libre de Bruxelles (ULB); 2LCFC-­Laboratoire de
Cartographie Fonctionnelle du Cerveau, Hôpital Erasme; 3Neurologie
Pédiatrique, Hôpital Universitaire Des Enfants de la Reine Fabiola
(HUDERF), Brussels, Belgium
Objectives/Introduction: Idiopathic Focal Epilepsy (IFE), in which
benign epilepsy with centro temporal spikes or with occipital parox-
ysms are best known, is the most encountered epileptic syndrome in
school-­age children. It is characterized by infrequent focal seizures,
interictal epileptiform discharges (IEDs) becoming more abundant
during sleep and usually a favorable outcome. However, persistent
cognitive alterations are frequently observed in these patients in-
cluding, among others, verbal (declarative) deficits. This challenges
the use of ‘benign’ terminology and promotes the new appellation of
Self-limited Focal Epilepsy (SFE). In this study, we tested the hypoth-
esis that children with SFE will have reduced sleep-­dependent mem-
ory consolidation performance compare to Typically Developing
(TD) children using a novel verbal declarative task.
Methods: Sleep-­dependent declarative memory consolidation per-
formance was compared between 13 children with SFE and 15 age-­
sex-­matched TD children (7–12 years old). Participants learned new
associations between 50 non-­objects and their functions. The effect
of sleep was evaluated by comparing immediate (evening, session 1,
S1) and delayed (morning, session 2, S2) retrieval performance be-
tween groups.
Results: A repeated measures ANOVA with a within-­subject fac-
tor SESSION (S1 vs. S2) and a between-­subject factor GROUP (SFE
vs. TD children) showed no main effect of GROUP (p = 0.16) and
no main effect of SESSION (p = 0.57), but a significant GROUP by
SESSION interaction [F (1.26) = 5.64; p = 0.02]. Post-­hoc LSD Fisher
test showed that children with SFE had significantly poorer retrieval
performance after a night of sleep (S2 < S1; p = 0.048), whereas
TD children retrieval performance was similar between sessions
(S2 = S1; p = 0.16). Immediate retrieval performance (S1) did not dif-
fer between groups (p = 0.44).
Conclusions: Results show that children with SFE have reduced
sleep-­
dependent declarative memory consolidation performance
compared with TD children. They suggest that IED in SFE may dis-
rupt brain processes underlying sleep-­related memory consolidation.
Disclosure: Nothing to disclose.
P539 | Effects of eslicarbazepine as add-­on
therapy on sleep architecture in temporal lobe
epilepsy
A. Romigi1; A. D'Aniello2; M. Caccamo1; G. Vitrani1; S.
Casciato2; B. Di Gioia1; F. Testa1; D. Centonze1; G. Di
Gennaro2
1
Sleep Medicine Center; 2Epilepsy Surgery Center, IRCCS Neuromed
Istituto Neurologico Mediterraneo Sleep Medicine Centre Pozzilli,
Pozzilli, Italy
Objectives/Introduction: Studies looking at the effect of antiseizure
medications (ASMs) on the sleep microstructure of subjects with
epilepsy are scarce. The aim of this study is to evaluate the effects of
ABSTRACTS
eslicarbazepine (ESL) as add-­on therapy on the sleep microstructure
in temporal lobe epilepsy (TLE).
Methods: Twelve patients affected by TLE were recruited to un-
dergo an overnight polysomnography and a subjective evaluation of
nocturnal sleep utilizing the Pittsburgh Sleep Quality Index (PSQI)
and daytime somnolence through the Epworth Sleepiness Scale
(ESS) before and after three months of treatment with ESL as add-
­on therapy. Ten healthy controls (HC) matched for age, sex and BMI
were recruited. Scoring and analysis of sleep macrostructure and cy-
clic alternating pattern (CAP) parameters were performed.
Results: Ten patients completed the study. The comparison between
patients in basal condition (T0) and HC showed a significant lower
sleep efficiency (p = 0.049),REM percentage (p = 0.002),higher REM
latency (p = 0.02),N2 (p = 0.001) and WASO (p = 0.01). Regarding
CAP, patients at T0 showed higher CAP rate in N1 (p = 0.01), lower
A1(%) (p = 0.03), higher A3(%)(p = 0.01), higher mean duration of
A (p = 0.02) and A3 (p = 0.006), A3 index (p = 0.02) than HC. ESL
did not induce any significant changes in nocturnal macrostructural
polysomnographic variables and PSQI scores. Furthermore, the ESS
score showed no modification after treatment. Lower CAP rate in N3
(p = 0.02), phase A2 index (p = 0.02) average number of CAP cycle
per sequences and mean duration of CAP sequences (both p = 0.02)
was evident after ESL. A trend toward significance was evident for
the decrease of CAP rate in N1 (p = 0.09) and N2 (p = 0.09), and for
the increase of B phase mean duration (p = 0.07).
Conclusions: We found significant improvement in sleep continuity
as measured by CAP after ESL. These findings suggest that ESL may
positively modulate sleep fragmentation in patients with TLE, and
hence ameliorate sleep quality. Our findings suggest a favourable
sleep profile with the use of ESL.
Disclosure: Study Funding EISAI LTD unconditionally funded the
present study.
P540 | Continuous positive airway pressure
prescription in pediatric obstructive sleep apnea
during Covid-­19 pandemic
C. Pía; A. Alvarez Ruiz deLarrinaga; P. Rodriguez Rodriguez;
L. Guerra Martín; D. Díez Fuente; A. Palomares Tobías; B.
Abad Brazo; M. Azpiazu Blocona; C. Egea Santaolalla; J.
Duran Cantolla
Araba University Hospital, Vitoria-­Gasteiz, Spain
Objectives/Introduction: Adenotonsillectomy has been the recom-
mended treatment for obstructive sleep apnea (OSA) in paediatric
population. However, Continuous positive airway pressure (CPAP)
is one of the therapeutic options that reduces morbidity. CPAP is
recommended in cases where OSA persists after surgery, OSA due
to non surgical comorbility and when surgery is contraindicated.
The aim of our study is to describe the raise in number of CPAP pre-
scriptions during Covid19 pandemic.
|
      329 of 356
Methods: A retrospective review of pediatric patients with CPAP
treatment at the Araba University Hospital between January 2017
and May 2020.
Results: Over a 3 year period, CPAP therapy was indicated for 24
children: 15 boys and 9 girls, age 8 years (SD 4). These children had
a median apnea hypopnea index (AHI) of 39.9 (SD 15.9) at the mo-
ment of diagnosis. The reasons for CPAP indication included severe
OSA persistence after surgery (41.6%), surgical delay in severe OSA
patients (37.5%), OSA due to obesity (8.3%) and OSA due to non
surgical condition (4.1%). CPAP treatment was stopped in 8 children
(33.3%), just in 2 patients CPAP was stopped after surgery resolu-
tion (25%).
CPAP prescriptions were grouped as period pre-­Covid 19 and post-­
Covid19. During the period pre-­Covid19, CPAP treatment were indi-
cated in 21 children (index 0.5 CPAP per month).
While Spain was in the acceleration phase of the Covid19 pandemic,
period post-­Covid19 (between March and May 2020), due to contain
the spread of the virus in our hospital, surgical activity were delayed,
resulting in an increase of the number of CPAP prescripcions until
reaching a ratio of 1.5 CPAP per month, increasing in 300%.
Conclusions: During the current health emergency, CPAP treatment
becomes the first line of treatment in children with severe OSA.
To evaluate the CPAP efficacy in these population, monitoring the
CPAP adherence in the next months must be needed.
Disclosure: Nothing to disclose.
P541 | Perception of infant sleep problems:
associations with infant temperament and
maternal mood
R. Burdayron1,2; B.P. Butler1,2; M.-J. Béliveau2,3; K. Dubois-
Comtois2,4; M.-H. Pennestri1,2
1
Department of Educational and Counselling Psychology, McGill
University; 2Hôpital en Santé Mentale Rivière-­des-­Prairies (CIUSSS-­
NIM); 3Département de Psychologie, Université de Montréal, Montreal;
4
Département de Psychologie, Université du Québec à Trois-­Rivières,
Trois-­Rivières, QC, Canada
Objectives/Introduction: Infant temperament and maternal de-
pression have been associated with maternal perceptions of infant
sleep problems. However, infant sleep parameters are rarely taken
into consideration. Moreover, the relation between anxiety and per-
ceptions of infant sleep problems among mothers remains largely
unknown. This study aimed to investigate whether infant tempera-
ment and maternal mood (depression, anxiety) predicted the degree
to which mothers perceived infant sleep to be problematic at six
months postpartum, independent of infant nocturnal sleep duration.
Methods: Participants were 54 mothers (Mage = 33.00 years,
SD = 3.86, range = 26–40) of 6-­month-­old infants. Infant tempera-
ment was measured using the negative affectivity factor of the Infant
Behavior Questionnaire – Revised. Maternal depressive and anxious
 |
330 of 356       ABSTRACTS
symptoms were assessed using standardized measures. The degree
to which mothers perceived their infant's sleep as problematic was
assessed using the Sleep Practices Questionnaire. Nocturnal infant
sleep duration was retrieved from a two-­week infant sleep diary via
maternal report. Hierarchical regression analyses were conducted
to determine whether infant temperament and maternal mood pre-
dicted mothers’ perceived extent of infant sleep problems while
controlling for infant sleep duration and covariates (maternal age,
parity).
Results: In the first model, higher levels of infant negative affectivity
(β = 0.28, p = 0.017) and maternal depression (β = 0.36, p = 0.001) sig-
nificantly predicted a greater extent of perceived infant sleep prob-
lems after adjusting for infant sleep duration and covariates. In the
second model, higher levels of infant negative affectivity (β = 0.26,
p = 0.031) and maternal anxiety (β = 0.36, p = 0.001) significantly
predicted a greater extent of perceived infant sleep problems after
adjusting for infant sleep duration and covariates.
Conclusions: Findings suggest that mothers with greater symptoms
of depression and anxiety and mothers of infants with greater nega-
tive affectivity perceive their infant's sleep to be more problematic,
regardless of their infant's sleep duration. Mothers who report infant
sleep problems may benefit from sleep interventions that also target
well-­being and coping with difficult infant temperament. Future re-
search should explore the relationships among temperament, mood,
and perceptions of sleep problems using prospective designs while
accounting for objectively measured infant sleep.
Disclosure: Nothing to disclose.
P542 | Poor sleep after mild traumatic brain
injury is associated with increased inflammation
in warfighters
J. Pucci1; S. Mithani2; J. Leete2; C. Lai2; R. Nakase-
Richardson3; K. Kenney1; J. Gill2; K. Werner1
1
Neurology, Uniformed Services University of Health Sciences;
2
National Institutes of Health, Bethesda, MD; 3Internal Medicine,
University of South Florida, Tampa, FL, United States
Objectives/Introduction: Mild traumatic brain injury (mTBI) and
sleep dysfunction are independently associated with elevated in-
flammation. Acutely after mTBI, cytokines related to inflammation,
such as interleukins-­6 (IL-­6), 10 (IL-­10) and tumor necrosis factor
alpha (TNFα), are elevated for days to months before declining. In
some patients, especially those with multiple and/or penetrating
head injuries, chronic activation of microglia can last for years and
has been associated with impaired functional recovery and mental
health disorders. IL-­6, IL-­10 and TNFα elevation has also been associ-
ated with sleep dysfunction, a phenomenon over half of TBI patients
experience. We hypothesized that inflammation from mTBI would
propagate in those with sleep dysfunction and that inflammatory
cascades involving IL-­6, IL-­10 and TNFα may serve as mechanistic
links between sleep dysfunction and mTBI.
Methods: In a retrospective cross-­
sectional cohort of warfight-
ers (n = 137 mTBI, 44 controls), the Pittsburgh Sleep Quality Index
(PSQI) was compared with exosome and plasma IL-­6, IL-­10, TNFα (av-
erage 10 years from last mTBI). Single Molecule Array achieved pro-
tein quantification. Tests assumed a type I error of p < 0.05. Linear
models controlled for age, sex, and body mass index.
Results: In the mTBI cohort, poor sleepers (PSQI ≥ 10) had elevated IL-­
6, pg/mL [standard deviation], (exosomes: 0.47 [0.63] vs 1.01 [1.54],
p = 0.04, d  =  0.44; plasma: 5.00 [13.31] vs 6.88 [13.51], p = 0.03,
d = 0.14) compared to good sleepers (PSQI < 10). In our model, PSQI
was the strongest predictor of IL-­6 exosomes (βstd = 0.27, p = 0.03)
in mTBI, whereas, BMI predicted IL-­6 in controls. Poor sleepers with
mTBI had less IL-­10 (exosome: 0.30 [0.54] vs 1.71 [8.18], p = 0.017).
However, these findings were reversed after removing two outliers
(>40 pg/mL). IL-­10 was significantly elevated in mTBI poor sleepers
(exosome: 0.134 [0.14] vs 0.30 [0.54], p = 0.005) and IL-­10 correlated
with PSQI (R = 0.23, p = 0.008) in the mTBI cohort. No differences in
TNFα were observed in mTBI groups. In controls, no differences in
any biomarker were observed.
Conclusions: Warfighters who report poor sleep have significantly
elevated inflammatory and varying levels of anti-­inflammatory inter-
leukins after chronic mTBI. Poor sleep may contribute to prolonged
activation and elevation of cytokines after mTBI. These findings may
have therapeutic implications.
Disclosure: Study funded by: DoD: Contract W91YTZ-­13-­C-­0 015/
HT0014-­19-­C-­0 004 with VHA Central Office VA TBI Model Systems
Program of Research/DHA Contracting Office (CO-­NCR) HT0014.
P543 | Diffusion tensor magnetic resonance
imaging of hypothalamus in traumatic brain injury
warfighters with sleep dysfunction
B. Gerstenslager
Uniformed Services University of Health Sciences, Bethesda, MD,
United States
Objectives/Introduction: While sleep disorders occur in 40–70% of
traumatic brain injury (TBI) patients, the pathophysiology remains
unknown. The hypothalamus is a master regulator of sleep and res-
piratory functions and may be injured following TBI. We hypoth-
esized that TBI patients with poor sleep quality by polysomnogram
(PSG) may have microstructural injury to hypothalamic sleep cir-
cuitry and that this may be detectable by diffusion tensor imaging
(DTI).
Methods: The TBI population included 193 warfighters with mild to
severe TBI. 61 controls without PSG were included. Age, body mass
index (BMI), diffusion magnetic resonance imaging (MRI), DTI sca-
lars of the hypothalamus and PSG were gathered. The diffusion MRI
was acquired by a 3T scanner. DTI scalar values were derived and
ABSTRACTS
mapped to the structural diffusion MRI with segmented hypotha-
lamic nuclei. Data analysis was then performed in R.
Results: There were no statistically significant differences in mean DTI
scalar values between TBI and control. There was a significant differ-
ence in mean age (TBI 37.6 + /− 6.5 years vs control 33.3 + /− 7.1 years,
p < 0.001) but no difference in mean BMI. Obstructive sleep apnea
(OSA) was noted in 63% of TBI. Linear modeling of sleep outcomes as
functions of BMI, age and DTI metrics in moderate/severe OSA TBI
patients (AHI > 15 events/hour) compared to all TBI patients demon-
strated significant correlation of AHI with fractional anisotropy (FA) (ꞵ
0.17, p < 0.043) but not age (ꞵ 0.10, p > 0.05) or BMI (ꞵ 0.04, p > 0.05).
Conclusions: We report prevalence of OSA 10 times greater than the
general U.S. military population. This sleep dysfunction may not be
due to hypothalamic injury because DTI was similar between TBI and
control. TBI patients, however, demonstrated a positive correlation
of hypothalamic FA with AHI. Increasing FA may indicate perilesional
gliosis in gray matter13. FA of the hypothalamus may therefore serve
as a potential imaging biomarker of moderate/severe OSA in TBI.
Larger longitudinal studies are necessary to better elucidate imaging
biomarkers of sleep circuitry disruption in TBI. If further studies find
imaging biomarkers of sleep circuitry disruption, early patient identi-
fication may aid recovery from TBI from improved sleep.
Disclosure: The opinions and assertions expressed herein are those
of the authors and do not necessarily reflect the official policy or
position of the Uniformed Services University or the Department
of Defense. This research protocol was reviewed and approved by
the National Intrepid Center of Excellence institutional review board
(IRB). This work was prepared by a military or civilian employee of the
US Government as part of the individual's official duties and there-
fore is in the public domain and does not possess copyright protec-
tion (public domain information may be freely distributed and copied;
however, as a courtesy it is requested that the Uniformed Services
University and the author be given an appropriate acknowledgement).
P544 | Association between sleep and
behaviour in school in gifted children with or
without a neurodevelopmental disorder
R. Théoret1,2; L. Bastien1,2; R. Godbout1,3
1
Sleep Laboratory & Clinic, Hôpital en Santé Mentale Rivière-­
2
des-­Prairies, CIUSSS du Nord-­de-­l’Île-­de-­Montréal; Psychology;
3
Psychiatry, Université de Montréal, Montréal, QC, Canada
Objectives/Introduction: Gifted children (GC) frequently present
behavioral and emotional issues at school, and more for in those with
a neurodevelopmental disorder (GC+NDD). Because the prevalence
of sleep problems is high in NDD children and given the impact of
poor sleep on daytime functioning, we investigated the association
between sleep and behavior in GC and GC+NDD children.
Methods: Twelve GC (9.4 ± 1.8 years old) and eleven GC+NDD
(10.4 ± 1.8 years old) children were studied. Sleep difficulties was
|
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assessed by the Children's Sleep Habits Questionnaire (CSHQ). Total
sleep time minutes (TST) was measured with actigraphy for two weeks.
Behavior at school was evaluated with five scales from the Teacher
Rating Scale of the Behavior Assessment System for Children, 3ed.
(BASC-­3 TRS): Externalizing Problems (EP), Internalizing Problems
(IP), School Problems (SP), Behavioral Symptoms Index (BSI), and
Adaptive Skills (AS). Moderation analysis determined whether group
affiliation moderates the relations between sleep and behavior.
Results: There were no differences between GC and GC+NDD chil-
dren on Sleep difficulties (41.09 vs. 40.00), TST (467.18 vs. 465.55),
EP (55.18 vs. 55.09), IP (53.55 vs. 50.91), SP (48.55 vs. 55.18), BSI
(55.45 vs. 55.27), and AS (52.36 vs. 45.45). Group affiliation moder-
ated the association between Sleep difficulties and SP (B = -­0.66,
p < 0.01): it was positive and significant in GC (B = 0.66, p < 0.01), but
not significant in GC+NDD (B = −0.49). Group affiliation also mod-
erated the SD/AS association (B = 0.59, p < 0.05): it was positive in
GC+NDD (b = 0.66, p < 0.01) but not significant in GC (B = −0.29).
Group affiliation did not moderate the associations between SD and
EP (B = −0.17), IP (B = −0.20) nor BSI (B = −0.41). No significant mod-
erations of group affiliation were found for the associations between
TST and any of the BASC-­3 TRS composites.
Conclusions: Despite no group differences on sleep and Basc-­
3
measures, sleep difficulties were associated with more school prob-
lems in GC, but not in GC+NDD; sleep difficulties in GC+NDD were
rather associated with more adaptive skills. This suggests that gifted
children with NDD and sleep difficulties are able to reinforce their
adaptive skills at school. TST as measured with actigraphy does not
seem to covary with behavior at school as measured by BASC-­3 TRS.
Disclosure: Nothing to disclose.
P545 | Poor sleep quality predicts plasma
markers of neurodegeneration and cognitive
deficits in warriors with mild traumatic brain
injury
J.K. Werner1; P. Shahim2; J. Pucci1; C. Lai2; J. Gill2; R.
Nakase-Richardson3,4; R. Diaz-Arrastia5; K. Kenney1
1
Neurology, Uniformed Services University of Health Sciences;
2
National Institutes of Health, Bethesda, MD; 3Internal Medicine,
University of South Florida; 4Defense Veterans Brain Injury Center,
Tampa, FL; 5Neurology, University of Pennsylvania, Philadelphia, PA,
United States
Objectives/Introduction: Increasing evidence links neurodegenera-
tion to traumatic brain injury (TBI), and a separate body of literature
links neurodegeneration to sleep dysfunction, implicating increased
toxin production and decreased glymphatic clearance. Sleep disor-
ders affect 50% of TBI patients, yet the sleep-­neurodegeneration
connection in these patients remains unexplored. We hypothesized
that warfighters with TBI and sleep dysfunction would have increased
neuronal injury, revealing potential mechanistic underpinnings for
 |
332 of 356       ABSTRACTS
TBI outcomes. We measured plasma biomarkers, cognitive function
and sleep dysfunction for correlation analysis.
Methods: In a retrospective cross-­sectional study of warfighters
(n = 113 chronic mild TBI patients), the Pittsburgh sleep quality
index (PSQI) was compared with amyloid beta 42 (Aβ42), neuro-
filament light (NFL), tau, and phospho-­tau (threonine 181) isolated
from plasma and exosomes. Executive function was tested with the
categorical fluency test. Exosome isolation was achieved via pre-
cipitation from plasma. Protein quantification was achieved with the
Single Molecule Array (Quanterix). Linear models were adjusted for
age, ApoE, and number of TBIs.
Results: Poor sleepers with TBI (PSQI > 8) had elevated NFL com-
pared to good sleepers both from plasma (p = 0.007) or exosomes
(p = 0.00017), and PSQI directly correlated with NFL (plasma:
Beta = 0.23, p = 0.0079; exosomes: Beta = 2.19, p = 0.0013) stronger
than any other marker of neuronal injury. Poor sleepers also showed
higher obstructive sleep apnea (OSA) risk by STOP-­BANG scores
(3.6, SD = 1.6 vs 2.8, SD = 1.74; p = 0.0014) as well as decreased
categorical fluency (20.7, SD = 4.1) compared to good sleepers (18.3,
SD = 4.6, p = 0.0067). Poor sleepers also showed decreased cat-
egorical fluency (20.7, SD = 4.1) compared to good sleepers (18.3,
SD = 4.6, p = 0.0067). They also had elevated STOP-­BANG scores
(p = 0.001). Plasma total tau and Aβ42 also correlated with PSQI
(Beta = 0.64, p = 0.028, and Beta = 0.40, p = 0.049 respectively).
Conclusions: This is the first reported data correlating markers of
neuronal injury and cognitive deficits with sleep complaints and OSA
risk in patients with TBI – possibly identifying treatable pathophysi-
ological mediators of TBI neurodegeneration. Limitations include a
small sample size, lack of objective sleep measures, and inability to
establish directionality due to cross-­sectional design. Prospective
trials will be required to further explore our proposed hypothesis. If
confirmed, these findings would call for targeting sleep disorders in
the TBI population to mitigate risk of neurodegeneration.
Disclosure: This work was supported by grant funding from:
Department of Defense, Chronic Effects of Neurotrauma
Consortium (CENC) Award W81XWH-­13-­2-­0 095 and Department
of Veterans Affairs CENC Award I01 CX001135.
P546 | Sleep and emotional state after
concomitant traumatic brain and spinal cord
injuries
M. Regniez1,2; C. Henri1,2; C. Provost2; J. Dufort-Gervais2;
M. Martinez1,2,3; V. Mongrain1,2
1
Department of Neuroscience, Université de Montréal; 2CIUSSS-­NIM;
3
Groupe de Recherche sur le Système Nerveux Central, Montréal, QC,
Canada
Objectives/Introduction: Traumatic brain and spinal cord injuries
(TBI and SCI) can lead to long-­term disabilities. Although the epi-
demiology, medical complications and prognosis of isolated TBI and
SCI have been well described, there are limited data on sleep and
emotional behaviour for concurrent TBI and SCI, which represent
a frequent clinical situation. Our hypothesis is that combined TBI
and SCI will modify sleep architecture and electroencephalographic
(EEG) activity in rats, in parallel to emotional regulation.
Methods: The EEG has been recorded in rats submitted to TBI and
SCI (n = 10), SCI alone (n = 10) and in control (sham, n = 11) animals
before and after injuries at acute (7 d.) and chronic (28 d.) phases.
The duration and quality of wakefulness and sleep was compared
between groups at the different phases. Emotional state was tested
using the open-­
field and sucrose preference test at the chronic
phase (35 d.), together with memory evaluations in Y-­maze and the
spatial object recognition tests.
Results: Our results point to some modifications of sleep architec-
ture in TBI-­SCI notably changes in the number of individual episodes
of sleep. Concomitant SCI and TBI is leaving memory and anxiety-­
like behavior unaffected (Y-­maze time spent in new arm, Main Group
effect F2,27 = 0.7, p = 0.5; Open field time spent in central zone,
Main Group effect F2,28 = 0.3, p = 0.7), but increases sucrose pref-
erence (Main Group effect F2.139 = 4.9, p = 0.009; Sham vs TBI-­SCI
p = 0.006).
Conclusions: Analyses of wakefulness and sleep data are in progress
and will include spectral analysis of the EEG as well as correlations
with emotional state. The finding of an increased preference for
sucrose in TBI-­SCI rats may suggest the development of a suscep-
tibility to addiction after multiple traumatic injuries of the central
nervous system.
Disclosure: Nothing to disclose.
P547 | Variability in natural history,
polysomnographic and polygraphic findings in
residual pediatric obstructive sleep apnea: an
interim analysis of recruitment candidates for
ERMES randomized clinical trial
M. Fernández-Barriales1,2; M. López deLuzuriaga3; A.
Álvarez4; L. Guerra Martin4; J.M. Aguirre-Urizar5; C. Egea
Santaolalla4
1
Servicio de Cirugía Oral y Maxilofacial – Unidad Funcional de Sueño,
Hospital Universitario Araba; 2Departamento de Cirugía, Radiología
y Medicina Física, Universidad del País Vasco (UPV/EHU), Vitoria-­
Gasteiz; 3Estomatología I, Universidad del País Vasco (UPV/EHU),
Bilbao; 4Unidad Funcional de Sueño, Hospital Universitario Araba,
Vitoria-­Gasteiz; 5Estomatología II, Universidad del País Vasco (UPV/
EHU), Bilbao, Spain
Objectives/Introduction: The ERS Task Force on the diagnosis and
management of obstructive SDB in childhood published in 2016
started acknowledging that ‘prospective cohort studies describing
the natural history of SDB […] are scarce’. Unlike adult OSAS, where
ABSTRACTS
relentless worsening throughout patient's lifespan is to be expected,
pediatric OSAS’ prospects remain elusive. Disease may spontane-
ously worsen or alleviate and fluctuate across development stages.
Even gold-­
standard treatment with adenotonsillectomy performs
unpredictably when compared to watchful waiting, 46% of the latter
normalizing polysomnographic findings at seven months. On top of
that, simplified diagnostic tests are known to underestimate sever-
ity of the disease but represent a widely adopted commitment in a
number of health systems.
Methods: Spontaneous normalization of polygraphic findings in 5
consecutive recruitment candidates for an ongoing randomized clini-
cal trial (Rapid maxillary expansion for treatment of residual pediatric
obstructive sleep apnea; acronym ERMES: NCT02947464) with pol-
ysomnographic evidence of disease persistence after adenotonsil-
lectomy prompted a methodological change in the original protocol
to include complete overnight polysomnography as the diagnostic
tool of choice. Therefore, such set of patients overwent consecu-
tive polysomnography, polygraphy and polysomnography again. We
performed a descriptive analysis of demographic, clinical and sleep
study parameters throughout the three consecutive sleep tests.
Results: A total of 9 post-­adenotonsillectomy pediatric OSA patients
were evaluated, 5 with full return study with three consecutive sleep
tests (PSG-­HST-­PSG). No statistical significance was expected due
to the small sample size, and still paired sample t tests of obstruc-
tive AHI showed significant differences in post-­surgical PSG vs re-
peated HST (p < 0.05) and repeated HST vs repeated PSG (p < 0.05).
Oddly, but not so much considering the sample was comprised of
patients who failed to cure with adenotonsillectomy, pre and post-­
surgical obstructive AHI PSG findings were the ones not significant
(p > 0.05).
Conclusions: We are still unable to consistently predict pediatric
OSA behavior over time. Adding uncertainty with a suboptimal di-
agnostic tool may hinder analysis of research results, particularly in
fields not fully understood as residual disease. Spontaneous cure or
alleviation in residual pediatric sleep apnea after adenotonsillectomy
seems feasible and should be controlled into any research attempt
in this field.
Disclosure: Nothing to disclose.
P548 | Online adaptation of a child-­parent
sleep training for 5–10 years olds – acceptance
and first results
A.A. Schlarb
Psychology, Clinical Psychology and Intervention, Bielefeld University,
Bielefeld, Germany
Objectives/Introduction: Sleep problems as difficulties initiating
sleep or sleep maintenance problems are common among school-­
children. Telehealth interventions may represent a future direction
to reduce barriers and problems of delivery regarding adequate
|
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treatments for sleep problems in children. A recent review found
only six studies concerning web-­based treatment for children and
their parents as a multi-­component intervention. In these studies in-
tervention for children were parent focused. In addition, due to the
CORONA-­crisis, adaptation of evaluated treatments was necessary.
Therefore, we adapted the CBT-­I KiSS-­training as an online treat-
ment for children and parents.
Methods: Due to the circumstances of CORONA the pilot study is
going on with various assessments as acceptance and first effects.
Instruments are sleep diaries, sleep related questionnaires as the
CSHQ, mental health based on Child Behavior Checklist (CBCL), pa-
rental stress (SCL-­90) and others. Pre-­post data will be assessed.
Results: 12 families participate at KiSS online. Besides acceptance
of treatment regarding children and parents, re-­post effects are cal-
culated based on CSHQ and sleep diary data. A multivariate analysis
of covariance (MANCOVA) to analyze pre-­post data is calculated.
For further multivariable comparison between different sleep pa-
rameters and parental variables a stepwise discriminant analysis is
implemented. Significant results (p < 0.05) and effect sizes according
to Cohen are described.
Conclusions: New ways regarding sleep help are required – espe-
cially due to the CORONA-­crisis. This is an adaptation of a well-­
established sleep treatment (KISS) for children and their parents to
reduce barriers to successful sleep intervention.
Disclosure: Nothing to disclose.
P549 | The relationship between sleep
continuity, tobacco smoking and cortisol
secretion among young adults
A. Cohen; I. Haimov
The Max Stern Academic College of Emek Yezreel, Emek Yezreel, Israel
Objectives/Introduction: Chronic tobacco smoking leads to the de-
velopment of adverse psychological symptoms, which may produce
a compulsive urge to smoke in order to alleviate these sensations. As
sleep disturbances are often considered among the negative conse-
quences of chronic smoking, the current study aimed at examining
whether dysregulation of the hypothalamic-­pituitary-­adrenocortical
(HPA) axis may be involved in this disruption of sleep quality among
smokers
Methods: The participants of this study were young adults aged
18–28, either regular smokers or non-­
smokers. The participants
provided saliva samples following awakening for assessment of
cortisol concentrations as a measure of HPA activity. Subsequently
the participants completed the State-­Trait Anxiety Inventory, Brief
Questionnaire on Smoking Urges, the Fagerstrom Test for Nicotine
Dependence, and the Pittsburgh Sleep Quality Index. Next, The
participant´s sleep was continuously monitored for 1 week with a
wrist actigraph.
 |
334 of 356       ABSTRACTS
Results: The study included 77 participants, 38 of them being regu-
lar smokers and 39 non-­smokers. While smokers´ self-­reported sleep
quality was similar to that of non-­smokers, their sleep recording data
pointed to diminished sleep continuity (increased wake time after
sleep onset; WASO) [F(1,75)  = 4.15; p < 0.05], while total sleep time
and sleep onset latency were similar to that of non-­smokers. Cortisol
secretion was higher among higher among smokers (0.73 ± 0.58 µg/
dL) compared to non-­smokers (0.47  ±  0.26  µg/dL) [F(1,75)  =  6.34,
p < 0.05] . However, among smokers only, cortisol was negatively
correlated with WASO (r = −0.49; p < 0.01), suggesting that the di-
rect enhancing effect of smoking on WASO is somewhat balanced
by an indirect process related to higher cortisol levels.
Conclusions: Smoking is associated with reduced sleep continuity
and the relationship between smoking and sleep continuity may in-
volve the HPA axis.
Disclosure: Nothing to disclose.
P550 | Does sleep mediate the association
between PTSD symptoms and pain in trauma-­
affected refugees?
J. Friis
Competence Center for Transcultural Psychiatry, Ballerup, Capital
Region, Denmark, Ballerup, Denmark
Objectives/Introduction: The aim of this study was to examine if
sleep disturbances mediated the association between PTSD symp-
toms and pain in trauma-­affected refugees.
Methods: The study was based on data from a randomised controlled
trial examining treatment of sleep disturbances in trauma-­affected
refugees. Participants included 219 patients referred to treatment
at a tertiary mental health service outpatient clinic in the Capital
Region of Denmark – the Competence Centre for Transcultural
Psychiatry (CTP). Longitudinal data was used to investigate possi-
ble mediation. The participants completed self-­administered rating
scales pre-­and post-­treatment. Analyses were conducted to test
sleep disturbances (measured on Pittsburgh Sleep Quality Index) as
a mediator between PTSD symptom severity (measured on Harvard
Trauma Questionnaire) and pain severity and interference (meas-
ured on Brief Pain Inventory) controlled for demographic covariates.
Mediation was analysed within a path analysis framework by con-
ducting multiple linear regression.
Results: Results from analysis on bivariate relationships among
study variables demonstrated that sleep disturbances were signifi-
cantly associated with pain interference and PTSD symptom sever-
ity (p < 0.05 for each)
Conclusions: Sleep disturbances are associated with both pain in-
terference and PTSD symptom severity. The study is the first to
investigate if sleep is a mediator of the association between PTSD
and pain in trauma-­affected refugees and thus contributes with new
knowledge and possible clinical implications for treatment of sleep
disturbances and symptoms of pain in trauma-­affected refugees.
Disclosure: Nothing to disclose.
P551 | Psychiatric characteristics and sleep
quality among people living with HIV
S. Akbarpour1; K. Sadeghniiat1; A. Najafi1; M. Mahboobi2;
M. Bazargani3; Z. Gholamypour4; S. Ghodrati1; P. Afsar
Kazerooni2
1
Occupational Sleep Research Center, Baharloo Hospital, Tehran
University of Medical Sciences; 2Center for Disease Control (CDC),
Ministry of Health and Medical Education; 3Tehran University of
Medical Sciences; 4Iran University of Medical Sciences, Tehran, Islamic
Republic of Iran
Objectives/Introduction: Psychiatric problems and sleep quality
among people living with HIV/AIDS (PLWH) is associated with HIV
treatment response, prognosis and high risk behaviors. There are
only few studies regarding these problems in Iranian HIV positive
patients. This study aimed to assess sleep quality and psychometric
properties in this group of patients.
Methods: Patients were recruited from Voluntary Counselling and
Testing (VCT) centers, in Tehran, capital city of Iran. Participants com-
pleted a questionnaire by help of trained interviewers. Questionnaires
included Pittsburgh Sleep Quality Index (PSQI), Depression Anxiety
Stress Scales (DASS), demographic and treatment variables.
DASS ≥ 10 and PSQI > 5 were defined as depression and poor sleep
quality. The data was analyzed by T-­student test and chi-­square test.
Results: The study population included 87 HIV positive (men  =  72),
aged  ≥  20 years with mean age of 40.25  ±  9.71  years. About 54
(62.1%), 44 (50.6%), and 67 (77%) of patients had abnormal scores
for depression, anxiety and stress, respectively. About 67.8% of pa-
tients had a global PSQI score of more than 5 with mean PSQI score
of 7.17 (SD = 2.73). There were no statistically significant different
between men and women regarding psychometric properties and
sleep quality but patients with these problems had lower CD4 count
in their last CD4 examination.
Conclusions: The results showed high prevalence of poor sleep qual-
ity and psychiatric problems in HIV positive patients with lower CD4
count. This issue demonstrated that this group of patients should
be prioritized for implementing urgent preventive strategies against
psychiatric problems and poor sleep quality.
Disclosure: There is no conflict of interest.
ABSTRACTS
P552 | A case series of non-­24-­hour-­Sleep
Wake Disorder (N24SWD) in sighted patients
K.J. van Rijn; K.W. van Kralingen
Sleep Wake Centre, SEIN, Zwolle, The Netherlands
Objectives/Introduction: Our circadian and sleep-­wake rhythm is
synchronized with the daily light-­dark cycle. In blind patients with-
out light perception, a non-­24-­hour-­sleep wake disorder (N24SWD)
occurs in 67 percent [1] . This sleep disorder can be recognized by a
typical pattern in sleep diaries and/or actigraphy report. A N24SWD
in the sighted (SN24SWD) has been proposed to be rare and to be
preceded by a delayed sleep wake phase disorder (DSWPD) [2, 3] .
A high prevalence of psychiatric co-­morbidity has been found prior
and after developing a SN24SWD .
A study among 51 patients show that SN24HSWD was preceded by
major depression, obsessive-­compulsive disorders and generalized
anxiety disorder. Of these patients 93,7% showed social withdrawal
[4]. The aim of this study is to examine the psychiatric comorbidity in
SN24SWD patients in our tertiary sleep clinic.
Methods: In 2018/2019 fourteen patients were diagnosed with
SN24SWD in our sleep clinic. Sleep-­characteristics were obtained by
polysomnography, two week actigraphy and when possible repeated
assessment of Dim Light Melatonin Onset (DLMO), with an interval of
two weeks. Additional medical and psychiatric history was obtained.
Results: The initial referral reason varied from suspicion of a circadian
rhythm sleep wake disorder to insomnia, hyper somnolence during
the day and inability to attend school due to the sleeping problem.
From the fourteen patients 13 were male (93%) and 1 female (7%),
age 16–30 years, the mean age 23,3 year. All patients (100%) had a
prior history of DSWPD. All patients (100%) were diagnosed with
a neurodevelopmental disorder (Autism Spectrum Disorder [ASD]
and/or Attention-­Deficit/Hyperactivity Disorder AD(H)D].
Prior substance abuse (cannabis and/or hard drugs) was reported by
5 patients (36%). All patients fulfil the criteria for another psychiatric
diagnosis, varying from prior addiction to depression and obsessive
compulsive disorder. Retrospectively, the onset of the SN24HSWD
in all patients was reported to be in adolescence or young adulthood.
Conclusions: The psychiatric phenotype in SN24HSWD consists
mainly of young males with a comorbid neurodevelopmental dis-
order. Other risk factors might be a prior diagnosed DSWPD and/
or psychiatric co-­morbidity and the use of (soft) drugs. We strongly
advise alertness to SN24HSWD especially in young males with ASD.
Disclosure: Nothing to disclose.
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P553 | Prevalence of Circadian Rhythm Sleep –
Wake disorders in Cyprus
F. Frangopoulos1; I. Nicolaou1; S. Zannetos1; N.-T.
Economou2; T. Adamide1; A. Georgiou1; G. Trakada3
1
Respiratory Department, Nicosia General Hospital, Strovolos, Nicosia,
Cyprus; 2Division of Pulmonology, Department of Clinical Therapeutics,
National and Kapodistrian University of Athens School of Medicine,
Alexandra Hospital, Athens, Greece; 3Division of Pulmonology,
Department of Clinical Therapeutics, National and Kapodistrian University
of Athens School of Medicine, Alexandra Hospital, Athens, Greece
Objectives/Introduction: There is an absence of data regarding the
clinical procedures for diagnosis and the prevalence of Circadian
Rhythm Sleep-­Wake Disorders (CRSWDs) in the general popula-
tion. Clinical practice is mainly based on a scientific understanding
of pathophysiology and empirical clinical evidence. Also, reported
prevalence is variable due to different case definitions, data collec-
tion methods, and environmental factors.
The aim of our study was to assess the prevalence of CRSWDs in the
general population of Cyprus, the southeast part of Europe and to
suggest some practice parameters – as a guide – for the appropriate
assessment of unnatural sleep schedules by preset sleep time limits,
according to imposed local environment.
Methods: Two hundreds fifty (250) adults (age: 21–83 years) were
randomly selected to further participate in a clinical assessment for
possible CRSWDs.
Results: From 195 enrolled participants (response rate 78%), 128
males – 65.6% and 67 females – 34.4%, criteria for CRSWDs ful-
filled 25 individuals (12.8%). The two most prevalent disorders were
Delayed sleep-­wake phase disorder (DSWPD) (10, 5.1%) and Shift
Work Sleep Disorder (SWD) (13, 6.7%). Less prevalent disorders in-
cluded Irregular sleep-­wake rhythm disorder (ISWRD) (1, 0.5%) and
Advanced sleep-­wake phase disorder (ASWPD) (1, 0.5%). Affected
individuals were middle aged (49.64 13.87 years old), with no dif-
ference concerning gender. Sleep onset differed statistically sig-
nificant between CRSWDs group and individuals without CRSWDs
(p = 0.002), whereas sleep offset time did not, as the individuals had
to comply with morning obligations. Time in bed was less for the
CRSWDs group (6.5 h ± 1.23, versus 7.16 h ± 1.09 in general popula-
tion, p =  0.017). CRSWDs patients tended to have more naps per
week (p = 0.031) and to sleep more during day offs, weekends and
holidays (p = 0.005). Main complains were symptoms of insomnia, as
expressed by Athens Insomnia Scale (AIS) (p = 0.002), sleepiness, as
expressed by Epworth Sleepiness Scale (ESS) (p = 0.002), and depres-
sion, as expressed by Beck Depression Inventory (BDI-­II) (p = 0.001).
Conclusions: According to our data, CRSWDs are common in the
general population of Cyprus, especially DSWPD and SWD. Affected
individuals suffer from sleep deprivation and usually complain about
insomnia, sleepiness and depression.
Disclosure: Nothing to disclose.
 |
336 of 356       ABSTRACTS
P554 | Long-­term outcome of a series of patients
with narcolepsy type 1 and comorbidity with
immunopathological and autoimmune diseases
F.J. Martínez-Orozco1; M. Fernández-Arquero2; J.L. Vicario3;
L. Lillo-Triguero 4; B. Rodríguez-Lozano5; R. Peraíta-Adrados6
1
Sleep Unit, Clinical Neurophysiology Service, San Carlos University
Hospital, Complutense University of Madrid; 2Immunology Service,
San Carlos University Hospital, Complutense University of Madrid;
3
Histocompatibility, Blood Center of the Community of Madrid;
4
Neurology and Sleep Unit, Ruber International Hospital; 5School of
Medicine, San Carlos University Hospital, Complutense University of
Madrid; 6Sleep and Epilepsy Unit-­Clinical Neurophysiology Service,
University General Hospital Gregorio Marañón, Madrid, Spain
Objectives/Introduction: We published our series of patients with
Narcolepsy type 1 (NT1) to evaluate the comorbidity with autoimmune
(AD) and other immunopathological diseases (ID), and we found that
16.6% had one or more ID associated (1). In a later case control-­study
with the same series we found a higher frequency of ID (30 patients,
18.99%), and the results demonstrated that there was a significantly
higher frequency of AD in NT1 patients (OR = 3.17, p = 0.040) com-
pared to the general population in our area (2). The aim of this study is
to evaluate the outcome of our series in the last 6 years.
Methods: A series of 158 Caucasian NT1 patients (96 male, 62 fe-
male; average age 50.1 years) from the previous study has been
included. All but one case (familial case) are HLA-­
DQB1*06:02
positive. The diagnosis of narcolepsy was made according to the
International Classification of Sleep Disorders (ICSD-­3).
Results: Twenty one patients have been diagnosed with a new ID, 10
of them an AD (autoimmune thyroid disease, psoriasis, rheumatoid
arthritis, transverse myelitis, granuloma annulare, primary biliary cir-
rhosis, alopecia areata and antiphospholipid syndrome), and 11 with
other ID (allergic rhinitis, allergic asthma, atopic dermatitis, food al-
lergy and contact dermatitis). One patient was diagnosed with two
new AD. The overall prevalence of inmunopathological diseases in
this series is actually 29.11% (46 patients), 22 of them (13.92%) with
an AD, a percentage higher than estimated in the general population.
Conclusions: The prevalence of AD/ID is high in this series, sug-
gesting that NT1 might arise on a background of generalized sus-
ceptibility to immune-­mediated processes. The occurrence of an
immunopathological disease can in turn influence the development
of others in genetically predisposed individuals, which explains the
increased associations observed in our long-­term study.
References:
(1) Martínez-­Orozco et al. Narcolepsy with cataplexy and comorbid
immunopathological diseases. J Sleep Res 2014; Aug 23(4): 414-­9.
(2) Martínez-­Orozco et al. Comorbidity of Narcolepsy Type 1 with
Autoimmune Diseases and Other Immunopathological Disorders: A
Case-­Control Study. J Clin Med Res 2016; 8(7): 495–505.
Disclosure: Nothing to disclose.
P555 | Clinical experience of Pitolisant in
Sweden
H. Gretarsdottir1,2; I. Boström2; A.-M. Landtblom1
1
Neurology, Akademiska Sjukhuset, Uppsala; 2Neurology, University of
Linköping, Linköping, Sweden
Objectives/Introduction: The incidence of narcolepsy in Sweden
rose after the swine flu vaccination 2009-­10. This incurable disorder
may require lifelong treatment with psychostimulants against exces-
sive daytime sleepiness (EDS), antidepressants against cataplexy
and/or sodium oxybate treating both conditions. Some patients do
not tolerate these medications due to side effects including cardio-
toxicity, seizure and abuse potential. Pitolisant, a relatively new med-
ication is approved to treat narcolepsy being a histamine-­receptor
inverse agonist activating histamine release in the brain, promoting
wakefulness. In Sweden has this medication been prescribed after
the other treatments have not sufficed. It has less severe side effects
and can be used by patients who have cardiovascular and psychiatric
conditions, as well as previous abuse. Pitolisant reimbursement was
not approved, after having been on the market since 2016, and sub-
sequently the medication had to be discontinued.
The aim of this study was to evaluate the effectiveness of Pitolisant
in our narcolepsy patients and to monitor changes after the medica-
tion was stopped.
Methods: Narcolepsy patients treated with Pitolisant were identi-
fied through the Swedish Narcolepsy Register (NARK REG). Data
were collected using instruments such as EQ-­5D-­L and SF-­36, start
of Pitolisant, cataplexy scores and Epworth-­Sleepiness-­Scale (ESS).
Data after Pitolisant discontinuation is being collected both quantita-
tively and through qualitative research with focus group interviews.
Results: 16 patients were treated with Pitolisant, 47% reported im-
provement in cataplexy while there was no evident change reported
with ESS. Five of these patients were able to study/work fulltime
after starting Pitolisant. Several patients reported major improve-
ment in creativity, cognition and concentration. Some patients re-
ported significant positive improvement in their daily lives, which
was not evident in the quantitative analysis. The preliminary data
after discontinuation shows worsening.
Conclusions: Cataplexy was improved. ESS scores did not improve
after the treatment however spontaneous reports showed better
concentration and general wellbeing after trying Pitolisant. The ESS
appears to be insufficient in determining tiredness if used alone. We
need better instruments to evaluate narcolepsy patients.
Disclosure: Nothing to disclose.
ABSTRACTS
P556 | The Narcolepsy Monitor: an app to gain
insight in narcolepsy symptom burden
L. Quaedackers1,2; S. Pillen1,3; M. Van Gilst1,3; P. Van
Mierlo1; G.J. Lammers4; P. Bhaskar5; A. Vilanova3,5,6; M.
Westenberg6; P. Markopoulos2; S. Overeem1,3
1
Center for Sleep Medicine, Kempenhaeghe, Heeze; 2Department of
3
Industrial Design; Department of Electrical Engineering, Eindhoven
University of Technology, Eindhoven; 4Sleep-­Wake Center, SEIN,
Heemstede; 5Department of Intelligence Systems, Electrical
Engineering, Mathematics and Computer Science, Delft University
of Technology, Delft; 6Department of Mathematics and Computer
Science, Algorithms and Visualisation W&I, Eindhoven University of
Technology, Eindhoven, The Netherlands
Objectives/Introduction: Narcolepsy is a debilitating sleep disorder
caused by a deficiency in hypocretin signalling. Narcolepsy is typically
described by the classical ‘pentad’ of symptoms: excessive daytime
sleepiness, cataplexy, sleep paralysis, hypnagogic hallucinations and
fragmented sleep. However, the symptom spectrum of narcolepsy is
much broader, including for example psychiatric symptoms and psycho-
social problems. The symptom palette differs greatly between patients,
but also within patients, with symptom severity and impact varying
over time. Several screening and monitoring questionnaires have been
developed, however these are often limited to mentioned classical
symptoms. In addition, they typically mainly assess the frequency of
symptoms at a single time point. Recently we developed the Narcolepsy
Monitor, an app designed for long term monitoring of the subjective
severity of narcolepsy symptoms.
Methods: The Narcolepsy Monitor is available for download, and
users can opt to share their data anonymously for research pur-
poses. After download, users fill in some questions about their nar-
colepsy and complete the Ullanlinna Narcolepsy Scale (UNS). In the
app, users rank the experienced burden of individual narcolepsy
symptoms in a graphical interactive interface, choosing from a list of
twenty different symptoms. People are encouraged to use the app
as much as they like, with a reminder every 7 days.
Results: Six hundred and five people, whom reported being diag-
nosed with narcolepsy by a physician, downloaded the Narcolepsy
Monitor on their own initiative and used it at least one time. Mean
age was 33.3 ± 12.3 years, and the mean score on the UNS 20.0 ± 8.4
confirming the diagnosis of narcolepsy. Overall, the most reported
symptoms were daytime sleepiness, lack of energy and difficulty
concentrating. The least reported were problems at school, prob-
lems at work and problems in relationships. Differences were found
between age categories, but sleepiness persisted to be in the top 3.
Younger people (<20 years) reported more agitation, whereas older
people (>60 years) reported being more awake at night.
Conclusions: These initial experiences show that the Narcolepsy
Monitor is an easy tool to gather information about the presence
and the course of a broad variety of symptoms in narcolepsy.
Disclosure: Nothing to disclose.
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P557 | Is verbal memory impaired
in Narcolepsy type I? A preliminary
neuropsychological study
P. Medrano-Martínez1; A. Gómez-Sacristán2; R.
Peraita-Adrados2
1
Cardenal Cisneros University Center, Alcalá de Henares; 2Sleep and
Epilepsy Unit-­Clinical Neurophysiology Service, University General
Hospital Gregorio Marañón. Research Institute Gregorio Marañón.
Complutense University of Madrid, Madrid, Spain
Objectives/Introduction: Attention deficits in narcolepsy with cata-
plexy (NT1) patients have been extensively studied whereas memory
deficits are less studied showing controversial results. Previous stud-
ies demonstrate an impairment on sleep-­dependent consolidation
processes in NT1. Nevertheless, this impairment is not always sup-
ported by a standardized memory assessment. Our goal was to assess
attentional processes and memory in NT1 patients by standardized
neuropsychological testing and to compare the results to a control
group.
Methods: We studied 12 patients (9 men; mean age: 36,7 years) with
NT1 diagnosed with ICSD – 3 criteria and 14 control subjects (8 men;
mean age: 34,5 years) matched for age and gender. Five patients
were under stimulants in monotherapy and the remaining 7 patients
did not receive any medication for at least one month before the
assessment. All participants responded to questionnaires on sleepi-
ness [Epworth Sleepiness Scale, (ESS)] and depression symptoms
[Beck Depression Inventory-­II, (BDI-­II)]. The neuropsychological as-
sessment consists in evaluate attention and memory functions by
the D2 Attention Test and the Verbal Paired Associates (VPA) Test
from the Wechsler Memory Scale.
Results: We found significant differences between groups in
ESS (p = 0.000) and BDI-­II (p = 0.000) scores. Concerning atten-
tion assessment, NT1 group performed worse than the control
group (p = 0.041). They processed less stimuli than control group
(p = 0.046). No significant differences were found in VPA test.
Conclusions: Despite the difficulties observed in speed processing
and attention, NT1 patients showed similar performance in all vari-
ables in Verbal Paired Associates (VPA) Test.
Disclosure: Nothing to disclose.
 |
338 of 356       ABSTRACTS
P558 | Narcolepsy following the H1N1-­
pandemia/vaccinations in Norway – 10 year
update
M.M. Heier1; B.H. Hansen1; K.H. Bronder1; R. Viste1,2;
J. Vevelstad1; R.B. Grande1; H.T. Juvodden1; S.E.H.
Nordstrand1,2; K.M. Gautvik1,3; Y. Kamaleri4; J. Gjesvik1;
P.M. Thorsby5; J. Storsaeter6; S. Knudsen-Heier1
1
Nevsom – Norwegian Centre of Neurodev. Dis. and Hypersomnias,
Dept. of Rare Disorders, Oslo University Hospital, Norway; 2University
of Oslo/Institute of Clinical Medicine; 3Lovisenberg Hospital;
4
Department of Rare Disorders, Oslo University Hospital; 5Hormone
Laboratory, Oslo University Hospital; 6The National Institute of Public
Health, Oslo, Norway
Objectives/Introduction: Autumn/winter 2009–10, 2.2 million
Norwegians were H1N1-­vaccinated with Pandemrix® followed by a
marked increase in narcolepsy incidence. We present an update on
Norwegian narcolepsy cases from autumn/winter 2009–2019.
Methods: From spring 2010 all new Norwegian narcolepsy pa-
tients were centrally reported to our national hypersomnia exper-
tise center. Post-­H1N1 patients – defined as cases with disease
onset after autumn 2009, and narcolepsy according to International
Classification of Sleep Disorders 3rd edition – are presented.
Results: 261 confirmed narcolepsy/hypocretin deficiency cases
were identified, but 75/261 cases were excluded due to incomplete
data on H1N1-­vaccination or year of disease onset.
160/186 of included cases were H1N1-­vaccinated with Pandemrix®
prior to disease onset. Median age at disease onset was 12.0 years.
Of these 160 included H1N1-­vaccinated patients, 24 had narcolepsy
onset in autumn/winter 2009, 89 in 2010, 17 in 2011, 11 in 2012, 8
in 2013, 4 in 2014–15, 3 in 2016–17 and 1 in 2018–19. 3/160 had
disease onset after H1N1-­vaccination, but exact year of symptom
debut was unclear.
26/186 post-­H1N1 cases were not H1N1-­vaccinated. Median age at
disease onset was 15.0 years. 0 had disease onset autumn/winter
2009, 6 in 2010; 9 in 2011, 3 in 2012, 2 in 2013, 2 in 2014–15, 3 in
2016-­17, and 1 in 2018-­19.
Narcolepsy incidence was significantly increased in the H1N1-­
vaccinated versus non-­vaccinated patients during autumn/winter
2009, 2010, 2011, 2012, and 2013 (p < 0.05 for all years). Mean
diagnostic delay (year of disease onset to year of diagnosis) was
2.73 ± 2.1 years in the H1N1-­vaccinated group, and 2.43 ± 2.1 years
in the non-­vaccinated group. 71/108 H1N1-­vaccinated cases which
were later diagnosed during 2012–2019 actually had disease onset
in autumn/winter 2009–2010.
Conclusions: According to our current patient registration, the
Norwegian incidence of H1N1-­vaccinated narcolepsy versus non-­
vaccinated narcolepsy is increased from autumn/winter 2009–2013.
Considerable delay in diagnosis and reporting, and many incom-
pletely confirmed narcolepsy cases, indicate an even higher nar-
colepsy incidence during 2009–2019. Consequently, it may still be
premature to conclude that the final number of H1N1-­vaccination
associated narcolepsy cases in Norway is detected.
Disclosure: Nothing to disclose.
P559 | Treating and preventing depression by
addressing insomnia – long-­term follow-­up of
three RCTs
K. Blom; S. Jernelöv; V. Kaldo
Centre for Psyachiatry Research, Dept. of Clinical Neutoscience,
Karolinska Institutet, Stockholm, Sweden
Objectives/Introduction: Comorbid insomnia and depression is
common, but seldom adequately treated. Cognitive behavioral
therapy, CBT, for depression is recommended for these patients in
most guidelines, but the most common treatment is antidepressants,
sometimes combined with sleep medication. Studies show that this
is not adequate to treat insomnia and thus prevent relapse into de-
pression. We present data from three RCT's on insomnia with de-
pression or depressive symptoms.
Methods: Study 1. Participants (N = 43) with insomnia and major
depression received either therapist-­guided Internet-­based cogni-
tive behavioral therapy for insomnia (ICBT-­i) or therapist-­guided
Internet-­based cognitive behavioral therapy for depression (ICBT-­d).
Study 2. Participants (N = 143) with insomnia but without major de-
pression received either ICBT-­i or an active Internet-­based control
treatment (ICBT-­c trl).
Study 3. Participants (N = 126) with insomnia and major depression
received either a new combination treatment, encompassing meth-
ods from both CBT-­i and CBT for depression, or depression treat-
ment with a placebo intervention for insomnia.
Results: Study 1. Results show that the two treatments, ICBT-­i and
ICBT-­d, were equally effective in reducing depression, but ICBT-­i
was significantly more effective in reducing insomnia. The results
were maintained at the 3 year follow-­up.
Study 2. Post treatment and at the 6 months follow-­up, ICBT-­i was
more effective in reducing insomnia severity than the control treat-
ment. For the whole sample, persistent good sleep at post-­, 6-­and
12 months follow-­up predicted significantly less depressive symp-
toms at the 3 year follow-­up.
Study 3. Preliminary results imply the new combination treatment is
superior to the control treatment, with similar effects on depression
but superior effects on insomnia.
Conclusions: These results underline the importance of providing
evidence based insomnia treatment (CBT-­
i) to patients with co-­
occurring insomnia and depression.
Disclosure: Nothing to disclose.
ABSTRACTS
P560 | The efficacy of cognitive behavioral
therapy for insomnia (CBT-­I) in a sample of
Egyptian patients
N. Hani1; S. Loza2; M. Khalil3; A. Saleh3
1 who self-­reported nightly snoring and screened negatively for sleep-­
Psychology; 2The Cairo Center for Sleep Disorders; 3Psychiatry
Department, Faculty of Medicine Cairo University, Cairo, Egypt
Objectives/Introduction: Cognitive Behavioral Therapy for Insomnia
(CBT-­I) is an evidence-­based therapeutic intervention for patients
suffering from Insomnia that is recommended in the most recent
insomnia treatment guidelines. Several researches have shown that
CBT-­I is a simple and safe intervention that provide sustained im-
provements in sleep quality of patients when compared to pharma-
cological interventions.
This study aims to measure the efficacy of CBT-­I in a sample of
Egyptian patients suffering from insomnia. The CBT-­
I treatment
manual was translated into Arabic language to render it suitable for
use among Egyptian and Arabic speaking patients.
Methods: The study was an experimental follow-­up study that in-
volved 49 Egyptian patients (40 females and 9 males with mean
age of 38.69 ± 14.36 years) fulfilling the ICSD-­3 criteria of Insomnia
disorder, who were seeking treatment at Cairo Center for Sleep
Disorders. 42 (85.7 %) patients completed 4 to 6 sessions of indi-
vidual CBT-­I that were delivered by a trained clinical psychologist
on a face to face basis. Patients were instructed to reduce hypnotic
medications gradually over a period of 2 weeks prior to the first ses-
sion. They were assessed prior to and after CBT-­I using the Insomnia
Severity Index (ISI), Beck Depression Inventory (BDI) and Beck
Anxiety Inventory (BAI).
Results: Results show a statistically significant reduction in the ISI
score from a mean of 22.24 ± 5.81 before CBT-­I to 11.81 ± 4.53 after
CBT-­I (P ˂ 0.001). Moreover, there was a statistically significant re-
duction in the BDI and BAI scores (P ˂ 0.001).
Conclusions: CBT-­I is a suitable and effective treatment option for
Egyptian patients suffering from insomnia.
Disclosure: Nothing to disclose.
P561 | Use of an adjustable bed base to
sleep in an inclined position shows significantly
reduced objective snoring and improved sleep: an
in-­home product effectiveness study
H. Rus; S. Danoff-Burg; M. Weaver; R. Raymann
SleepScore Labs, Carlsbad, CA, United States
Objectives/Introduction: Repositioning the head and upper body to
sleep in an inclined position has been associated with reduced snor-
ing and improved sleep. Accurately testing the effect of sleeping in
an inclined position on snoring and sleep in the real-­world comfort
|
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of the habitual bedroom is possible with recent advances in meas-
urement technologies. This study compared snoring and sleep out-
comes when sleeping in a flat position versus an inclined position
using the Dr. Oz Good Life™ adjustable bed base.
Methods: Participants (n = 25; 62% male; age 21–62 years, avg. 37)
disordered breathing and/or had BMI < 30 objectively tracked their
snoring and sleep while using the adjustable bed base at home for
over 990 nights. A non-­counterbalanced, within-­subjects, pre-­post
design was used. Participants were instructed to sleep flat on their
own mattress for four weeks before sleeping with their upper body
at a 12-­degree incline for four additional weeks while continuing to
track their snoring and sleep. Self-­report data were collected at the
beginning and end of the product use period. Nightly snoring was
measured using the Do I Snore or Grind app; nightly sleep was meas-
ured using SleepScore Max. Paired t-­tests and multilevel regression
were used to test for statistical significance.
Results: Across participants, snoring decreased by an average of 7%
while sleeping at the inclined position (p < 0.05) and descriptively
participants reported that snoring was less likely to disrupt their
sleep or a partner's sleep. Objective sleep also improved: 4% average
decrease in number of awakenings, 3% increase in BodyScore (meas-
ure of deep sleep), and 5% increase in proportion of the night spent
in deep sleep (ps < 0.05). In addition, participants reported increases
in ability to sleep through the night (+24%), feeling well-­rested in the
morning (+36%), and sleep satisfaction (+53%), (ps < 0.01).
Conclusions: Using objective snoring and sleep measurements and
self-­report, this study showed that sleeping with the upper body at
an incline has potential as a non-­obtrusive means of reducing snoring
and improving sleep in a non-­clinical snoring population.
Disclosure: All authors are employees of SleepScore Labs. CVB INC.
funded this research.
P562 | Correlation between severity of
insomnia, sleep quality and parameters
obtained from sleep calendar, actigraphy and
polysomnography in patients with chronic
insomnia
B. Cocho1; O. Manzanilla1; A. Horrillo1; P. Baptista2; A.
Campo3; I. Alústiza4; E. Aubá4; M. Alegre1; E. Urrestarazu1
1
Clinical Neurophysiology; 2Otorhinolaryngology; 3Pneumology;
4
Psychiatry and Psycology, Clínica Universidad de Navarra, Pamplona,
Spain
Objectives/Introduction: Chronic Insomnia is a highly prevalent
condition. In fact, 5–50% of global population are found to living
with insomnia syndrome or symptoms.
The aim of this study was to investigate the correlation between the
severity of insomnia measured by the Insomnia Severity Index (ISI)
 |
340 of 356       ABSTRACTS

and subjective and objective parameters of sleep in patients with
chronic insomnia.
Methods: The last 200 patients diagnosed of insomnia in our Sleep
Unit were screened retrospectively. Patients for whom full-­night
polysomnography (PSG), actigraphy (ACT), ISI and Pittsburgh Sleep
Quality Index (PSQI) were available were selected. Data of Sleep
Calendar (SC) if available, were also obtained.
The analyzed variables were: ISI and PSQI scores, total sleep time
(TST), sleep efficiency (SE), wakefulness after sleep-­onset (WASO)
and apnea-­hypopnea index (AHI).
Data analysis was performed using SPSS and Microsoft Excel.
Descriptive statistics, Chi-­
square and Pearson correlation were
used.
Results: A total of 36 patients fulfilled the selection criteria (15
women, 21 men) with an average age of 58,11 years (19–86). SC were
available in 20 of them. 32 patients presented comorbid OSA. The
average AHI was 12,44 (9,36 in women, 16,40 in men). There was no
correlation between AHI and ISI (r = −0.04, p < 0.01). There was a
moderate and positive correlation between ISI and PSQI global score
(r = 0.518, p < 0.01) and an inverse correlation (r = −0.448, p < 0.01)
between ISI and TST (question 4) according to PSQI.
ISI correlates with TST and SE measured by ACT (r  =  −0.191,
p < 0.01; r = −0.278, p < 0.01) and SC (r = −0.125, p < 0.01; r = −0.281,
p < 0.01) but not with PSG (r < 0.1, p < 0.01; r < 0.1, p < 0.01) respec-
tively. Finally, ISI correlates weakly with WASO measured by ACT
(r = 0.197, p < 0.01)
Conclusions: In patients with chronic insomnia, the Insomnia Severity
Index (ISI) correlated with sleep quality and sleep duration measured
by PSQI. Correlation was weaker with sleep parameters registered in
the actigraphy and, even weaker with those obtained from sleep cal-
endar. There was no correlation with parameters measured by one-­
night PSG. In our sample there was a high prevalence of comorbid
OSA but no correlation were found between ISI and IAH.
Disclosure: Nothing to disclose.
chronic medical conditions and especially in sleep disorders adher-
ence to treatment recommendations is low compared to adherence
in acute medical conditions. Despite that fact, studies on CBT-­
I
rarely include adherence behaviour as a matter of interest or the as-
sessment of adherence is limited to the average number of sessions
attended or to overall study attrition. The object of this study was to
examine the association between an indirect measure of adherence
to CBT-­I (pre-­to post-­treatment changes in bedtimes) and treatment
efficacy. Data was taken from a randomised control trial investigat-
ing the effects of CBT-­I on early markers of cardiovascular disease.
Methods: The sample consisted of 23 patients meeting DSM-­5 cri-
teria for insomnia disorder who were treated with 8 weekly sessions
of CBT-­I. For an estimate of adherence to sleep restriction therapy,
the sleep diary based pre-­to post-­treatment difference of time in
bed was calculated and correlated with the pre-­to post-­treatment
difference in insomnia severity. Furthermore, a detailed analysis of
adherence to different components of CBT-­I through sleep diary
data and videotapes of treatment sessions will be conducted for the
presentation at the conference.
Results: Results showed that the overall study attrition was high. On
average, the patients in the CBT-­I group attended 7.3 ± 1.3 treat-
ment sessions in 8.9 ± 3.0 weeks. The correlation of the pre-­to post-­
treatment difference of time in bed and the pre-­to post-­treatment
difference of insomnia severity was significant for the whole group
(r = 0.42, p =  0.00). Surprisingly, the correlation was mainly driven by
a significant correlation within the control group (r = 0.44, p = 0.04).
Contrary to expectations, the correlation was not significant within
the CBT-­I group (r = 0.19, p = 0.39).
Conclusions: CBT-­I treatment effects appear to be related to changes
in bedtimes from pre-­to post-­treatment. It remains unclear whether
the chosen measure is a valid indicator of treatment adherence since
the effect in this study was mainly driven by the control group.
Disclosure: Nothing to disclose.

P564 | Does restless legs syndrome also

P563 | Adherence behaviour in cognitive
behavioural therapy for insomnia: findings from a
randomised control trial
1 1 1 1
L. Steinmetz ; D. Riemann ; B. Feige ; F. Holub ; U. Akram
K. Spiegelhalder1; A. Johann1
1
Department of Psychiatry and Psychotherapy, University of Freiburg,
Faculty of Medicine, Freiburg, Germany; 2Department of Psychology,
Sheffield Hallam University, Sociology and Politics; 3Sleep and
Circadian Neuroscience Institute (SCNi), Nuffield Department of
Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
Objectives/Introduction: Insomnia disorder is often severe and
chronic with major impact on quality of life. The first-­line treat-
ment recommended by clinical guidelines is Cognitive Behavioural
Therapy for Insomnia (CBT-­
I). Previous studies suggest that in
involve cognitive dysfunction?
G. Kerkhof; R. Rijsman
Sleep Center, Haaglanden Medical Center, Den Haag, The Netherlands
2,3
;
Objectives/Introduction: Evaluate the available evidence regarding
the cognitive functioning of patients with Restless Legs Syndrome
(RLS).
Methods: Using Google Scholar and search terms: RLS, restless legs,
cognition, and cognitive, 16 empirical neuropsychological studies (a
list of references may be obtained from the authors) – all published in
or after the year 2000 – were identified comparing various groups of
RLS-­patients (total N: 1062) to healthy controls. Across these stud-
ies, different tests were administered, covering the following cogni-
tion domains: perception & orientation (1 test); learning & memory
(12 tests); attention & working memory (41 tests); verbal functions
ABSTRACTS
& language skills (4 tests); construction & motor performance (6
tests); concept formation & reasoning (7 tests); and executive func-
tions, decision making & mental flexibility (17 tests) (cf. Lezak et al.,
Neuropsychological Assessment. Oxford University Press, 2012).
Surprisingly, no studies were found applying performance tests for
the alertness and vigilance domain
Results: In the collection of 16 articles, 88 test administrations were
reported, 26 of which (i.e. 30%) revealed significantly worse scores
for the RLS-­patients vs. the controls, whereas the remaining 62 test
administrations failed to show a significant difference. It is striking,
however, that the percentage of significant differences increases
systematically across the cognition domains as listed above. While
the percentage of significantly worse RLS-­bound tests is quite low
for the learning & memory functions (i.e. 8%), it is highest for the
executive & decision making functions (i.e. 47%).
Conclusions: This qualitative summary of cognition studies in RLS
patients suggests that RLS-­related cognitive decline mainly concerns
the ‘higher order’, executive cognitive processes. These processes
particularly implicate the dopaminergic fronto-­striatal brain circuits.
Disclosure: Nothing to disclose.
P565 | PE2-­I PET of RBD, initial findings
1 2
R. Frandsen ; J. Bjerglund Andersen
1 2
Danish Center for Sleep Medicine; Clinical Physiology and Nuclear
Medicine, Glostrup Hospital, Glostrup, Denmark
Objectives/Introduction: At DCSM we have started using PE2I-­PET
on all patients that presents with RBD. Since late 2018 we have had
32 patients scanned (one patient twice). Of these 32 patients, two
had known Narcolepsy with RBD symptoms, one had a mixed REM
and Non-­rem parasomnia with RSWA/RBD that has persisted since
childhood, 26 patients were iRBD or RSWA, and 4 had RBD and
were under evaluation for DLB.
Methods: The PE2I-­PET scanners are evaluated using a developed
z-­score where normal subjects have a value between −2 and 2 (the
standard deviations). PD patients have a z-­score value of less than
−2. Z-­scores are calculated for left/right putamen and striatum and a
left/right Putamen/Caudatus ratio.
Results: Our RBD patients had an average z-­score of -­1.4 for left/
right putamen and striatum placing RBD in the middle of the spec-
trum between healthy controls and Parkinson's disease. The left and
right Putamen/Caudatus ratio has more variation with most RBD pa-
tients (19 of 30) averaging a z-­score of 0 and the remaining 11 with
an average z-­score of -­3.8.
Conclusions: When using PE2I the conversion-­point to PD is when
putamen drops below caudatus and the Putamen/Caudate ratio
starts dropping (the known marker for PD). This will miss those
converting to DLB. The marker for early neurodegeneration in RBD
seems to be the simultaneous drop in both putamen and caudatus
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before Putamen/Caudate ratio drops. À Possible imaging marker be-
fore conversion to PD or the ones that convert to DLB?
Disclosure: Nothing to disclose.
P566 | Cognitive function in idiopathic
REM-­sleep behavior disorder under long-­term
melatonin treatment
D. Kunz1,2; S. Stotz1,2; B. Frederik1,2
1
Clinic for Sleep-­& Chronomedicine, St. Hedwig-­Krankenhaus;
2
Institute of Physiology, Charité – Universitätsmedizin Berlin, Berlin,
Germany
Objectives/Introduction: Rapid-­eye-­movement sleep behavior dis-
order (RBD) is recognized as the most reliable prodromal biomarker
of synucleinopathies such as Lewy body dementia and Parkinson's
disease. There is evidence that a high proportion of patients with
iRBD show cognitive deficits and that these appear in the same
domains as in synucleinopathies, with attentional and executive
functions being the most affected. In the present study, cognitive
performance of iRBD patients was examined repeatedly before and
during long-­term melatonin treatment.
Methods: The extended German version of the Consortium to
Establish a Registry for Alzheimer's Disease (CERAD-­
Plus – 11
subtests) was used to evaluate cognitive abilities on the domains
language, memory, attention/praxis and orientation. In 127 iRBD pa-
tients the CERAD-­Plus was performed at least once after six months
of melatonin treatment with an average follow up of 3.1 ± 2.8 years
(range: 0.5–21.7 yrs). For further analyses, only those who were
untreated at baseline and examined multiple times (n = 77) were
included in a linear mixed model, with 110 follow-­up examinations
compared at three different time points to cognitive performances
at baseline.
Results: Cognitive abilities in iRBD patients on long-­term melatonin
treatment did not decline over time and even improved on several
subtests, with significant main effects seen for the subtests ‘Wordlist
Encoding – verbal memory’ (F3,108 = 7.39, p < 0.001) and ‘Trail Making
Test – Part A-­visual attention performance’ (F3,105 = 7.43, p < 0.001).
Categorizing patients into low, medium, and high performers at
baseline showed that low and medium performers improved over
time in verbal memory (F6,123 = 5.12, p < 0.001) and visual attention
(F6,117 = 3.29, p = 0.005), with low performers tending to achieve
cognitive levels that were clinically inconspicuous.
Out of 15 patients diagnosed with a neurocognitive disorder (NCD)
at baseline, 10 improved cognition in the course of melatonin treat-
ment. 7/10 did not fulfill the criteria for an NCD at follow-­up exami-
nations anymore.
Conclusions: Our data strongly suggest that long-­term administra-
tion of melatonin administered to patients with RBD improves atten-
tional and executive functions and deficits that are specific clinical
symptoms of prodromal synucleinopathies. Patients showing the
 |
342 of 356       ABSTRACTS
highest cognitive impairment at baseline improve most in their cog-
nitive abilities during treatment.
Disclosure: Nothing to disclose.
P567 | Mood disorders symptoms in REM and
NREM parasomnias
1,2 3 4 2
M. Ntafouli ; A. Bonakis ; P. Bargiotas ; C.L. Bassetti ; D.
Dikeos1
1 Objectives/Introduction: Sleep has been recognized as an essential
Sleep Research Unit, First Department of Psychiatry, National
2 component in athlete preparation and is suggested to be one of the
and Kapodistrian University of Athens, Athens, Greece; Sleep-­
Wake-­Epilepsy Center, Department of Neurology, Bern University
Hospital (Inselspital) and University Bern, Bern, Switzerland; 3Second
Department of Neurology, ‘Attikon’ University Hospital, National and
4 (19 men and 14 women, mean age 27.6 ± 4.8 years-­old) wore wrist
Kapodistrian University of Athens, Athens, Greece; Department of
Neurology, University of Cyprus, Nicosia, Cyprus
Objectives/Introduction: Parasomnias (greek ‘para’, meaning alongside
of, and latin word ‘somnus’ meaning sleep) are defined, according to the
American Academy of Sleep Medicine, as unpleasant or undesirable
physical events or experiences that occur predominantly or exclusively
during the sleep or during arousals from sleep. They are considered as
a consequence of dissociation between wakefulness, NREM or REM
sleep with behaviours characteristic of one state succeeding the other
and are classified according to the state they predominantly occur in: a)
rapid eye movement (REM)-­related parasomnias, b) non-­REM (NREM)-­
related parasomnias and c) other parasomnias.
Although parasomnias are nightime phenomena, there are indica-
tions that they may have an impact on daytime living of the patients
with the variety of symptoms.
The aim of the study is to investigate mood disorders symptoms
(anxiety, depression) and personality traits (impulsivity, anger) in
REM and NREM parasomnia patients.
Methods: We have recruited 28 patients with NREM and REM para-
somnias who underwent Polysomnography and performed neu-
ropsychiatric assessments. Daytime symptoms were assessed using
the Beck Depression Inventory (BDI), Depression Anxiety Stress
scale (DASS), Penn State Worry Questionnaire (PSWQ), State-­Trait
Anger Expression Inventory (STAXI) and the Barratt Impulsiveness
Scale (BIS-­1).
Results: Fifteen patients were diagnosed with REM parasomnias and
thirteen with NREM parasomnias. Nearly all patients were males, ex-
cept for one female patient with NREM parasomnia. Mean age of
patients with REM Parasomnias was 69 years old and with NREM
parasomnias 34 years old. Among the subjects in the REM group,
more than half had an increased score in anxiety (DASS(A) ≥ 8), and
40% of them had an increased depression score (BDI ≥ 14).
Conclusions: Mood disorders symptoms seem to be quite prevalent
among patients with REM parasomnias. These findings are of impor-
tance in understanding daytime consequences of parasomnias.
Disclosure: Nothing to disclose.
P568 | From pillow to soccer field, a real world
evaluation of sleep in elite players
M. Barata1; D. Duarte2; L. Guerra3; C. Egea3,4
1
Pulmonology Department, Hospital Garcia de Orta, Almada, Portugal;
2
Pulmonology Department, Clínica Valle del Lili, Cali, Colombia; 3Sleep
Unit OSI Araba, Vitoria-­Gasteiz; 4University of the Basque Country –
UPV/EHU, Basque Country, Spain
most effective recovery strategies. The aim of this study was to de-
scribe sleeping patterns of elite male and female soccer players.
Methods: Thirty-­three athletes of the 1st Spanish soccer division
actigraph units during nigh-­sleep throughout 2 consecutive weeks.
Demographic variables are collected, as well as Epworth Sleepiness
Scale (ESS) and Composite Scale of Morningness (CSM). Participant
mean and SD were calculated to form the between group compari-
sons (independent t-­test).
Results: The median value of ESS was 9.21 (3.4), varied be-
tween 3 and 16. One player with ESS of 16, were submitted to a
Polysomnography that revealed moderate OSA, and was treated
adequately. According to the CSM, 17 (57%) of the players were
intermediate morning type persons. As a group, the median player
TST was 07:08 h (0:29), without significant differences between
genders (7:08 in men vs 7:07 hours in women) and a TST coefficient
of variation of 7.8%. The median sleep efficiency (SE) was 82.4%,
with significant difference between genders (81.3% in men vs 83.9%
in women, p = 0.045). Sleep fragmentation index was 39.6%, with a
sleep latency (SL) of 37.6 minutes.
Conclusions: This study highlights the sleeping patterns of an elite
soccer team, revealing that athletes of both genders are able to
achieve TST and SE recommendations. However, and according to
observed in literature, the increased SL may have revealed an in-
crease incidence of insomnia problems in these athletes.
Disclosure: Nothing to disclose.
P569 | NREM parasomnias in the medical
residency period
M.D. Calabria Gallego; A. Sierra Gómez; F.J. González
Terriza; O. López Agudelo; J.A. Vizcaya Gaona; J.C. Morán
Sánchez
Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
Objectives/Introduction: Parasomnias are undesirable physical
events or sensorial experiences that can occur at the beginning, in
the meantime, or at the end of the sleep. The importance of diagnos-
ing them lies in the potential lesions that can occur secondary to the
ABSTRACTS
disorder, the interruption provoked of the sleep, bio-­psycho-­social
deterioration and the chance of making other diagnosis (sleep disor-
der or systemic disorder) that could be causing it.
Methods: Taking into account that these problems are meanly trig-
gered by an inadequate sleep environment, poor sleep hygiene,
sleep deprivation, alteration of circadian rhythms and other sleep
disorders, we identified the resident physicians of a third level hospi-
tal as a exposure population to these kind of risk factors for develop-
ing parasomnias.
In this way, we performed surveys among them, asking for the pres-
ence of different NREM (non – rapid eye movement) parasomnias,
explaining them, in first place, the exact definition of each one of
them. These were sleep terrors, confusional arousal, sleepwalking,
sleep-­related sexual disorders, and sleep-­related eating disorders.
We know the prevalence in a general population of these disorders
is: sleep terrors (1–2 % in adults), confusional arousal (4.2 %), sleep-
walking (1–4% in adults), sleep-­related sexual disorders (unknown
prevalence), and sleep-­related eating disorders (unknown, but esti-
mated to be 1–5% in general population) (Fleetham et al).
Results: In our study, we collected data from 72 resident physi-
cians. The majority of them (84.7%), were 25 to 30 years old. 73.6
% of them considered that the period of their residence training was
causing a worsening in the quality of their sleep. 86.1 % reported
sleep terrors, 41.7 % reported confusional arousals, 5.6% reported
sleepwalking, 6.9% reported sleep-­
related sexual disorders, and
1.4% reported sleep-­related eating disorders.
Conclusions: With the present survey, we can corroborate how the
period of medical residency triggers the appearance of NREM para-
somnias. We realize about the possibility of possible biases when
conducting the surveys, and the lack in relation to the absence of a
control group.
Disclosure: Nothing to disclose.
P570 | Do spike-­waves during slow wave sleep
affect sleep recovery in pediatric patients? First
steps towards an automated analyses approach
J. Skorucak; B.K. Bölsterli; S. Storz; S. Leach; B. Schmitt; G.
Ramantani; R. Huber
University Children's Hospital Zurich, University of Zurich, Zürich,
Switzerland
Objectives/Introduction: Continuous spike-­
wave epilepsy dur-
ing sleep is characterized by an activation of spike waves during
slow-­wave sleep, and it is associated with variable forms of neu-
ropsychological impairments [1]. We have provided evidence that
the sleep recovery function seems to be impaired in these patients
[2]. Application of sleep modulation technologies in order to inter-
act with epileptic activation during slow-­wave sleep could bring
new insights about a causal association between spike-­waves and
neuropsychological impairments. As a first step in this process, it is
|
      343 of 356
important to identify patient groups that show such impaired sleep
recovery. The goal of this study was to establish methods for auto-
matic processing of sleep recordings which allow large-­scale analysis
of spike characteristics and their impact on sleep.
Methods: Machine learning methods based on long short-­
term
memory (LSTM) neural networks were developed for automatic
spike and sleep detection in pediatric patients with continuous
spike-­wave epilepsy. Both classification algorithms were based on
raw data and expert labels.
Sleep recordings of 39 children diagnosed with different types of
epilepsy were available. For the automatic spike detection patients
were divided into two data sets: 27 for training of the algorithm
(15357 spikes), and 12 for testing (6876 spikes), and for the auto-
matic slow-­wave sleep detection data of 16 patients were used
for the training (33667 20-­s epochs), and 3 for testing (7248 20-­s
epochs).
Results: The algorithm successfully identified spikes with a high per-
formance (sensitivity = 81.0%, specificity = 97.8%, Cohen's kappa
coefficient = 0.81). The slow-­wave sleep detection algorithm showed
moderate performance (sensitivity = 89.6%, specificity = 66.8%,
Cohen's kappa coefficient = 0.54).
Conclusions: Our approach reliably detected spikes and slow-­wave
sleep in children with epilepsy and is now being tested in larger
datasets.
References:
(1) E. Roulet Perez, V. Davidoff, P. A. Despland, and T. Deonna,
“Mental and behavioural deterioration of children with epilepsy and
CSWS: acquired epileptic frontal syndrome,” Dev Med Child Neurol,
vol. 35, no. 8, pp. 661–74, Aug 1993.
(2) B. K. Bölsterli, B. Schmitt, T. Bast, H. Critelli, J. Heinzle, O. G. Jenni,
R. Huber, “Impaired slow wave sleep downscaling in encephalopathy
with status epilepticus during sleep (ESES)”, Clin Neurophysiol, vol.
122, no. 9, pp. 1779–1787, 2011.
Disclosure: Nothing to disclose.
P571 | Supplemental oxygen improves
respiratory stability in ex-­early preterm infants,
but not as well as non-­invasive ventilation: a case
study using polysomnography
S. Scaillet; D. Qachri; C. Lelong; C. Haggenmacher; D. Vens
Hôpital Universitaire Des Enfants Reine Fabiola, Brussels, Belgium
Objectives/Introduction: Supplemental oxygen (SO) is routinely
used in case of persisting cardiorespiratory immaturity in prema-
turely born infants. There is very little information on the use of
noninvasive ventilation (NIV) for home use to counteract cardiores-
piratory immaturity instead of SO. This case report describes the
effect of SO versus NIV on respiratory stability, using polysomnog-
raphy (PSG).
 |
344 of 356       ABSTRACTS
Methods: A 25 weeks 6/7 new born with bronchopneumodysplasia
(BPD) was discharged at 40 weeks post-­menstrual (PM) age. She had
four polysomnography studies: the first PSG (PSG1) one week previ-
ous to her discharge; She was re-­admitted a week later at 41 weeks
PM for worrisome alarms on the monitor. As she remained oxygen
dependent, she had a second PSG study (PSG2) at 43 weeks PM,
recorded without SO for the first part of the night, and with SO for
the second part of the night. NIV treatment with bilevel positive air-
way pressure (BIPAP) was used to wean her off oxygen. Just before
discharge, a third PSG (PSG3) at 44 weeks PM was performed with
NIV treatment.
A fourth and final PSG (PSG4) was recorded at 57 weeks PM, one
month after the NIV treatment during sleep had been suspended.
Results: PSG1 at 39 weeks PM showed some respiratory instability,
for which a cardiorespiratory monitor was given.
PSG2 at 43 weeks PM without SO (first part of the night) exhibited
great respiratory instability which was only partially corrected with
SO. The child was successfully weaned off the oxygen with BIPAP
treatment.
PSG3, recorded just before discharge at 44 weeks PM with BIPAP
was completely normalized. She kept the NIV during sleep for
8 weeks. PSG4 was normal.
Conclusions: Readmission at 41 weeks PM could be due to either
worsening of the BPD, or an infectious episode.
It is proposed that SO was able to partially improve respiratory sta-
bility as it corrects hypoxia. It is proposed that BIPAP treatment was
better at stabilizing respiratory control as it improves overall ventila-
tion, which in turn reduces chemoreceptors loop gain. This mecha-
nism has previously been proposed in an animal study where it was
observed that CPAP use eliminates periodic breathing.
Disclosure: Nothing to disclose.
P572 | Distress and adjustment difficulty due
to the covid-­19 pandemic in Israel: mediation
effect of sleep quality
O. Tzischinsky1; K. Asraf2; D. Hadar-Shoval2
1
Behavioral Science; 2Psychology, Emek Yezreel College, Emek Yezreel,
Israel
Objectives/Introduction: Israel's strategy for dealing with the
1 Marañón. Research Institute Gregorio Marañón. Complutense
COVID-­19 pandemic was to keep the population in home quaran-
tine and to maintain social distancing. The new situation can cause a
negative psychological impact as found by previous study during the
Equine Influenza epidemic in South America. In addition, as stated in
the literature, distress feelings are a precursor to insomnia develop-
ment. Insomnia can be a risk factor for Adjustment Difficulty (AjD)
due to COVID-­19 pandemic.
The aims were to examine:
1. The differences between 2 groups (with vs. without AjD) in
distress and sleep quality (Insomnia).
2. Whether Insomnia is a mediator between distress level and AjD
groups.
Methods: 439 subjects, mean age of 37.9 (± 16.5 yrs), 313 women
(71%), from the non-­infected community, participated in the study.
Tools: Demographic, Adjustment (ADNM-­
4), Distress (Anxiety,
Depression, Stress: DASS21), and Sleep quality (PSQI) questionnaires.
Procedure: The data collection took place over two weeks during the
home quarantine period, via an anonymous online questionnaire, at
the point when the number of COVID-­19 patients was at its peak,
and prohibitions regarding COVID-­19 were at their most severe.
Results: Dividing the sample into 2 adjustment groups (a score
greater than 8.5 indicative of AjD) revealed that 54% of the par-
ticipants presented difficulty adjusting to the COVID-­19. Significant
differences were found between the groups, in level of distress
(35.56 ± 12.38 vs. 27.14 ± 7.32 respectively; p < 0.001) and Insomnia
(PSQI-­total) (6.82 ± 2.49 vs. 5.98 ± 2.2 respectively; p < 0.001).
After controlling for age, distress predicted adjustment (OR = 1.11,
95% CI:1.08-­
1.14). as well as insomnia (b = 0.11, se = 0.005,
t(436)  = 11.61, p < 0.001). In addition, insomnia predicted adjust-
ment after controlling for age (OR = 1.34, 95% CI:1.22–1.46). The as-
sociation between distress and AjD groups was partially mediated by
insomnia (indirect effect = 0.01, se = 0.0065; 95% CI: 0.005, 0.031)
as 0 did not fall in the confidence interval, and stress still predicted
adjustment (OR = 1.09, 95% CI: 1.05–1.12, p < 0.001).
Conclusions: The strategy adopted in Israel to keep all the popula-
tion in home quarantine and to maintain social distancing has signifi-
cant psychological and behavioral effects, which include adjustment
difficulties, severe levels of distress mediated by impaired sleep
quality (Insomnia).
Disclosure: Nothing to disclose.
P573 | Long-­term follow-­up on the effects of
sodium oxibate on sleep architecture in patients
with narcolepsy type 1
P. Medrano-Martínez1; L. Lillo-Triguero2; P. López-Esteban3;
R. Peraita-Adrados4
1
Cardenal Cisneros University Center, Alcalá de Henares; 2Neurology
and Sleep Unit, Ruber International Hospital; 3Clinical Neurophysiology
Unit, Niño Jesús University Hospital; 4Sleep and Epilepsy Unit-­Clinical
Neurophysiology Service, University General Hospital Gregorio
University of Madrid, Madrid, Spain
Objectives/Introduction: Gamma-­
hydroxybutyrate (GHB) (sodium
oxybate) was administered for the first time in 1979 in 16 patients with
narcolepsy with cataplexy (NT1) that improved without development
of tolerance up to 20 month (1). Our series consists of 23 adults NT1
patients treated with sodium oxybate (SXB) up to 3 years to objec-
tively evaluate the effect on sleep architecture by polysomnography.
And additional goal was to study the presence of sleep comorbidities.
ABSTRACTS
Methods: Diagnosis of NT1 fulfilled the criteria of the I CSD-­3. The
initial dose of SXB was 3 g in two nocturnal doses of 1.5 g with an
interval of 2.5 to 3.5 hours. Dose was titrated to 4.5 g in 2 to 3 weeks
to the final dose (range, 4.5–9 g) with a trend towards more flexible
doses. The PSG at diagnosis (without medication) was repeated at
6 months of SXB treatment-­control 1; control 2 up to 1 year and con-
trol 3 up to 3 years. We compared the PSG parameters of 23 patients
at control 1 with those of 10 patients after and 3 years of treatment
with SXB -­control 3.
The PSG parameters analyzed were: sleep efficiency index, sleep la-
tency, Rem latency, WASO, stages: N1, N2, N3, and REM; total num-
ber of awakenings/h; AHI and PLMs indexes.
Results: All Caucasians patients were DQB1*02:06 positive except
a negative familial case. We performed a standard PSG in 23 NT1
adults patients (12 men) control-­1 with a nocturnal mean dose of
4.71 g and a PSG of 10 patients (5 men) control-­3 with a mean dose
of 5.47 g. The remaining 13 patients discontinued SXB because in-
sufficient compliance, pregnancy and side effects.
We only found significant differences in PSG control-­
3 with an
increased in stage N1 (p < 0.03) and in AHI (p < 0.08) and PLMs
(p < 0.04) indexes.
Conclusions: SXB is a well-­tolerated drug in low-­medium doses up to
3 years of uninterrupted treatment.
Tolerance and the presence of comorbidities at long-­term adminis-
tration pointed to a temporary withdrawal of the medication.
Disclosure: Nothing to disclose.
P574 | Impact of insomnia and experimentally
disrupted sleep on overnight memory
consolidation
X. Omlin; M. Reid; R. Sharman; J. Schneider; C. Espie; S. Kyle
University of Oxford/Sleep & Circadian Neuroscience Institute, Oxford,
United Kingdom
Objectives/Introduction: Sleep in healthy individuals has been
shown to promote the consolidation of newly acquired memories.
Evidence suggests that periods of sleep after learning facilitates
memory consolidation relative to wakefulness. Insomnia is recog-
nised as a 24-­hour disorder affecting not only sleep but also daytime
functioning. Cognitive impairment is commonly cited as a conse-
quence of sleep disruption but few studies have assessed overnight
memory consolidation in insomnia. We compared overnight memory
consolidation in people with insomnia to a group of good sleep-
ers who were randomised to either a normal night of sleep (unin-
terrupted sleep, US) or one night of sleep continuity disruption via
forced awakenings (FA).
Methods: We compared 49 good sleepers (37 female; mean age:
24 years, SD: 3.53), randomised to either one night of US (n = 23) or
one night of FA (n = 26), with 32 participants meeting criteria for in-
somnia disorder (27 female; mean age: 54 years, SD: 7.99) who were
|
      345 of 356
assessed at baseline as part of a randomised controlled trial. The
same word-­pair task and procedures were used in both lab-­based
studies. Overnight memory consolidation was calculated from the
difference in correctly recalled word pairs between evening and
morning recall. Statistical analysis was performed using a univariate
general linear model followed by post hoc least significant differ-
ence tests.
Results: We found significantly lower overnight memory consolida-
tion in the insomnia (mean: 4.7, SD: 5.9, p < 0.001) and the FA (mean:
6.7, SD: 4.1, p = 0.002) group compared to the US group (mean: 11.6,
SD: 5.3). However, following adjustment for age only the FA group
(p = 0.002), but not the insomnia group, showed significantly lower
memory performance than the US group.
Conclusions: Our findings suggest that overnight memory consoli-
dation is impaired in insomnia relative to normal sleep, however, we
cannot rule out an age-­related explanation given the difference in
ages between the study samples. Future work will assess whether
cognitive behavioural therapy improves overnight memory consoli-
dation in individuals with insomnia.
Disclosure: Nothing to disclose.
P575 | Sleep disorder patients during
COVID19: preliminary results from a
collaborative Portuguese network of Sleep
Laboratories
T. Paiva1,2,3; C. Bentes4; C. Pereira5; A. Feliciano6,7;
I. Luzeiro8; I. Pereira9; S. Moreira10,11; J. Pimentel6,12;
A. Carreiro13; A. Lino14; L. Andrade15; P. Bugalho16; F.
Sampaio17; H. Canhão2; M. Gaspar Matos3
1
CENC – Sleep Medicine Center, Lisboa; 2CHRC – Nova Medical
School; 3ISAMB – Faculdade de Medicina, Universidade de Lisboa;
4
Neurology, Centro Hospitalar Universitário Lisboa Norte, Lisbon;
5
Instituto de Sono e Medicina Dentária, Funchal; 6CENC – Sleep
Medicine Center; 7Clínica Lusíadas de Almada e Parque das Nações,
Lisbon; 8Centro Hospitalar Universitário Coimbra; 9Neurology,
10
Centro Hospitalar Universitário Coimbra, Coimbra; Pneumology,
11
Centro Hospitalar Universitário Lisboa Norte, Lisbon; Hospital dos
12
Lusiadas, Lisboa; Centro Hospitalar Vila Franca Xira, Vila Franca;
13 14
Hospital do Divino Espírito Santo, Ponta Delgada; Hospital Santo
15
Espírito da Ilha Terceira, Angra Heroismo; Centro Hospitalar Baixo
16
Vouga, Aveiro; Centro Hospitalar de Lisboa Ocidental, Neurology;
17
Neurology, Hospital Garcia de Orta, Almada, Portugal
Objectives/Introduction: COVID19 period with disease contamina-
tion risks, economic crisis and daily life changes has been a complex,
difficult and unexpected phase.
Elderly and people with chronic diseases were particularly at risk.
Therefore, it would be of major interest to evaluate Sleep Disorder
patients (SDP), who often fulfill the two major risks: older with
chronic diseases
 |
346 of 356       ABSTRACTS
Objectives:
1) To evaluate compliance of SDP during COVID
2) To establish a collaborative network of Sleep Laboratories
3) To compare in this framework the main SD diagnosis (Insomnia
and Sleep Apnea)
Methods:
1) Online survey addressed to SDP of the several laboratories, in-
vestigating the COVID confinement consequences, demograph-
ics, the work/mental health/ sleep/habits (prior and during)
and the effects upon disease, was used
2) The Sleep Lab network includes: CENC, the Sleep Labs of 6 main
Lisbon, Aveiro and Azoren public Hospitals, Sleep Labs of 3 major
Private Hospitals in Lisbon and Coimbra, a private Lab in Madeira.
Ethics Committee approval obtained at CENC
3) Data so far were collected at CENC, during 13/5 -15/6
4) Chi2 analysis, with z transformation, Bonferroni correction;
p > 0.05
Results:
1) Sample: 555 patients, 63% women, mean age 50.7 (20 to
87 years); BMI 25.9 + -7.32, with a mean duration of 50.7 + -
18.9 confinement days
2) This population is a scale 1–10, felt reasonably (6.8 + -1.8), were
not depressed (3.9 + -2.5), neither anxious (4.7 + -2.6), but were
worried with the situation (5.8 + -2.4). Their sleep and awakening
quality was average (5.6 + -2.2 and 5.85 + -2.1) with no significant
changes relative to prior COVID
3) Comparing Insomnia and Apnea showed significant impact in in-
somniacs who were more prone to be ‘fed up’, lonely, but in op-
position felt ‘less stress’ and made ‘important discoveries in their
lives’; in line with this they were the group with both higher per-
centages of both ‘got worse’, ‘got better’
4) More sleep apnea patients felt ‘OK’ and missed their family
Conclusions: Data do not support the ‘tragic’ perspectives concern-
ing COVID. Furthermore, they show the ambiguities of insomniacs
and open optimistic perspectives
More detailed analysis, larger databases are needed in order to iden-
tify risk factors and comorbidities specific for each sleep disorder.
Disclosure: Nothing to disclose.
P576 | Quantitative actigraphic analysis in
isolated REM sleep behavior disorder
1 2 2 1,3
M. Filardi ; A. Stefani ; E. Holzknecht ; F. Pizza ; G.
Plazzi1,3; B. Högl2
1 polysomnography) and daytime symptoms at baseline and under
Departement of Biomedical and Neuromotor Sciences, University of
2 mechanical treatment (customized dental guard) in a preliminary
Bologna, Bologna, Italy; Department of Neurology, Medical University
3 sample of 13 BS patients. A baseline polysomnography after inclu-
of Innsbruck, Innsbruck, Austria; IRCCS Istituto delle Scienze
Neurologiche di Bologna, Bologna, Italy
Objectives/Introduction: To evaluate whether quantitative acti-
graphic analysis is able to distinguish isolated REM sleep behavior
disorder (iRBD) patients from patients suffering sleep disorders with
pathological motor activity during sleep and healthy controls.
Methods: 19 subjects with iRBD, 19 restless leg syndrome pa-
tients (RLS), 20 untreated sleep apnea syndrome patients (OSA)
and 16 healthy controls underwent 2-­
week actigraphy, video-­
polysomnography, and completed several RBD questionnaires.
Results: iRBD patients have lower sleep efficiency (q < 0.05) with
increased frequency of prolonged awakenings (q < 0.05) compared
to RLS and controls. iRBD patients have more diurnal naps in com-
parison to all clinical groups and to controls (q < 0.005). Actigraphic
nonparametric measures not differ between iRBD patients and the
other groups. A 24-­hr measure that expresses the relationship be-
tween nocturnal and diurnal motor activity intensity (I < O) well dis-
tinguishes iRBD from other sleep disorders (q < 0.0005).
Conclusions: Our results indicate that actigraphic assessment may
have a relevant role in the diagnostic work up of iRBD. Actigraphy
analysis, alone or in combination with other tools (e.g. screen-
ing questionnaires), could represent an effective and easy-­to-­use
screening tool for iRBD.
Disclosure: Nothing to disclose.
P577 | Sleep related bruxism: beyond teeth
wear!
D. Neu1,2,3; M. El Yaagoubi4,5; R. Darrigade5; J. Newell1,2; O.
Mairesse1,6; R. Glineur5
1
Brugmann University Hospital, Sleep Laboratory & Unit for
Chronobiology U78, Université Libre de Bruxelles -­Brugmann Hospital;
2
Center for the Study of Sleep Disorders – Department of Neuroscience,
CHIREC Delta Hospital; 3UNI Neuroscience Institute: ULB312 Faculty
of Medicine and ULB388 FSM; 4Brugmann University Hospital,
Sleep Laboratory & Unit for Chronobiology U78; 5Department of
Stomatology and Dentistry – Erasme Academic Hospital, Université
Libre de Bruxelles; 6Department of Brain Body and Cognition (BBCO),
Vrije Universiteit Brussel, Brussels, Belgium
Objectives/Introduction: Sleep-­related bruxism (SB) is a condition
which appears to present with a potentially broader impact on sleep
quality, going way beyond the consideration of teeth wear. In the pre-
sent study we aim to quantify these relations with respect to sleep-­
wake schedules, sleep structure and clinical symptom assessments.
Methods: Within the framework of a prospective study, we compare
sleep parameters (by means of longitudinal actigraphy and repeated
sion (based on oro-­dental clinical diagnostic criteria) followed a one-­
week recording of sleep-­wake schedules (by means of actigraphy). A
second polysomnography was performed after a 2 week period of a
nightly dental guard appliance. Clinical symptom assessments were
ABSTRACTS
performed by means of classical scales (Pittsburgh Sleep Quality,
Fatigue Severity, Anxiety and Depression Scales, Insomnia Index…).
Results: While actigraphy recordings did not show differences in
time-­
in-­
bed or sleep-­
wake schedules and polysomnography did
not display differences with respect to sleep efficiency, duration
or sleep-­stage distributions, all symptom-­scales revealed however
significant differences after treatment (all p's < 0.0001). explorative
correlation analysis showed that only the total number of sleep-­
related bruxism-­event occurrences and the total cumulated duration
of SB were significantly correlated to impaired sleep quality alone
(respectively r = 0.530, p = 0.041 and r = 0.525, p = 0.042).
Conclusions: Based on these preliminary results, the present study
contributes to converging evidence, that SB seems to display sleep-­
related daytime impact that may go further than sleep fragmentation
on one hand and facial pain, dental wear and temporo-­mandibular
joint discomforts on the other.
Disclosure: Nothing to disclose.
P578 | A study on the prevalence of sleep
disorders in Scottish patients with multiple
sclerosis: how common is obstructive sleep
apnoea?
R. Munro; K. Stewart; R. Riha
University of Edinburgh, Edinburgh, United Kingdom
Objectives/Introduction: Poor sleep is common in patients with
multiple sclerosis (MS) and yet sleep disorders are often underdi-
agnosed. This study assesses the prevalence of sleep disorders in
Scottish MS patients and explores relationships between sleep dis-
orders and fatigue, day-­time sleepiness, and mood disorders.
Methods: MS patients carried out a self-­reported survey which was
posted online on Scottish MS social media groups and handed out at
an MS support group. The survey included the Fatigue Severity Scale
(FSS), the Epworth Sleepiness scale (ESS), the Hospital Anxiety and
Depression Scale (HADS), the Sleep Disorder Symptoms Checklist-­17
(SDS-­CL-­17) and STOP-­Bang questions. Standard statistical analysis
was undertaken.
Results: Ninety-­nine MS patients responded of which 86.9% tested
positive for at least one sleep disorder according to the SDS-­CL-­17
and 80.8 % scored positive for abnormal fatigue (FSS). However, only
8.1% reported a sleep disorder diagnosis. Moderate positive correla-
tions were observed between SDS-­CL-­17 OSA scores and ESS, FSS
and HADS (P < 0.001). STOP-­Bang scores also positively correlated
with FSS (P < 0.05), but not with ESS.
Conclusions: Sleep disorders, including OSA, are significantly under-
diagnosed in the Scottish MS population. Sleep disorders should be
routinely evaluated in MS patients, especially those struggling with
severe fatigue.
Disclosure: Nothing to disclose.
|
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P580 | Cross-­cultural comparison of sleep
patterns of typically developing children and
children with autism spectrum disorder in the UK
and South Korea
M. Jeon; E.J. Halstead; D. Dimitriou
Institute of Education, Psychology and Human Development, University
College London, London, United Kingdom
Objectives/Introduction: A limited number of cross-­cultural stud-
ies, including children with Autism Spectrum Disorder (ASD), have
explored sleep patterns and problems. Therefore, this study aimed
to compare sleep patterns of children with ASD and their typically
developing (TD) peers in both the UK and South Korea, by using par-
ent report and actigraphy.
Methods: One-­hundred sixty-­three school-­aged children were re-
cruited; 85 children in the UK (50 TD and 35 ASD) and 78 children in
South Korea (45 TD and 33 ASD). Children's sleep patterns and prob-
lems were measured with the Children's Sleep Habits Questionnaire
(CSHQ) and actigraphy.
Results: Objectively (actigraphy) measured sleep patterns showed
a significant difference in sleep latency between TD children and
children with ASD in the UK (p = 0.013). In contrast, a significant
difference was shown in wake after sleep onset (mins) between TD
children and children with ASD in South Korea (p = 0.047). The com-
parison of sleep patterns of children with ASD in the UK and South
Korea reported bedtime, time in bed, sleep latency, assumed sleep
time and actual sleep time (all p < 0.05).
The parent-­reported sleep problems showed significant differences
between TD children and children with ASD in the UK including bed-
time resistance, sleep onset delay, sleep duration, sleep anxiety and
overall sleep problems (all p < 0.05). In contrast, a significant differ-
ence was only shown in sleep onset delay (p = 0.031) between TD
children and children with ASD in South Korea. No significant differ-
ences were found when comparing the parent-­reported sleep pat-
terns of children with ASD in the UK and South Korea (all p > 0.05).
Conclusions: The current study indicates cultural differences in ob-
jectively measured sleep patterns of children with ASD in the UK
and South Korea; however, no cultural differences were shown in
parent-­reported sleep problems of ASD children in the UK and South
Korea. Furthermore, children with ASD in both the UK and South
Korea showed different sleep patterns and problems compared to
their TD peers, however, differences were not shown in the same
sleep subscales. Further studies are needed to examine the underly-
ing causes for these differences.
Disclosure: Nothing to disclose.
 |
348 of 356       ABSTRACTS
P581 | Epworth Sleepiness Scale Test – retest
reliability analysis in solriamfetol studies
1,2 3 4 3
R. Rosenberg ; K. Babson ; D. Menno ; S. Morris ; M.
Baladi3; D. Hyman3; J. Black3,5
1
NeuroTrials Research, Inc.; 2Atlanta School of Sleep Medicine, Atlanta,
3 4
GA; Jazz Pharmaceuticals, Palo Alto, CA; Jazz Pharmaceuticals,
Philadelphia, PA; 5Stanford Center for Sleep Sciences and Medicine,
Palo Alto, CA, United States
Objectives/Introduction: The Epworth Sleepiness Scale (ESS) meas-
ures excessive daytime sleepiness. This analysis examined test-­
retest reliability of ESS scores in participants with narcolepsy or
obstructive sleep apnoea (OSA) in solriamfetol studies.
Methods: Intraclass correlation coefficient (ICC) estimates and
95% confidence intervals (CIs) for ESS scores from two 12-­week
placebo-­controlled trials (1 narcolepsy [NCT02348593]; 1 OSA
[NCT02348606]) and one long-­term open-­label extension (OLE) trial
(narcolepsy or OSA; NCT02348632) were calculated separately for
each trial, based on assessments (at time-­point pairs) when scores
were expected to be stable (12-­week trials: at Weeks 4 and 8, 8 and
12, and 4 and 12; OLE: at Weeks 14 and 26/27, 26/27 and 39/40, and
14 and 39/40). ICCs were analysed for the overall population in each
trial and by treatment and adherence to primary OSA therapy. An
ICC > 0.7 has been recommended as a quality criterion for accept-
able test-­retest reliability.
Results: Overall ICC estimates ranged from 0.81 to 0.87 in the 12-­
week narcolepsy trial, from 0.74 to 0.80 in the 12-­week OSA trial,
and from 0.78 to 0.85 in the OLE trial. Specifically, in the 12-­week
narcolepsy trial, ICCs (95% CI) were 0.83 (0.79, 0.87) for Weeks 4 and
8 (n = 199), 0.87 (0.83, 0.90) for Weeks 8 and 12 (n = 196), and 0.81
(0.76, 0.85) for Weeks 4 and 12 (n = 196). In the 12-­week OSA trial,
ICCs (95% CI) were 0.74 (0.69, 0.78) for Weeks 4 and 8 (n = 416), 0.80
(0.76, 0.83) for Weeks 8 and 12 (n = 405), and 0.74 (0.69, 0.78) for
Weeks 4 and 12 (n = 405). In the OLE trial, ICCs (95% CI) were 0.82
(0.79, 0.85) for Weeks 14 and 26/27 (n = 495), 0.85 (0.82, 0.87) for
Weeks 26/27 and 39/40 (n = 463), and 0.78 (0.74, 0.81) for Weeks 14
and 39/40 (n = 463). Treatment (solriamfetol combined/placebo) or
adherence to primary OSA therapy did not impact reliability.
Conclusions: In 3 large clinical trials of participants with narcolepsy
or OSA, the ESS demonstrated an acceptable level of test-­retest
reliability.
Disclosure: R Rosenberg has received consultancy fees from
Eisai; honoraria from Merck; and research funding from Jazz
Pharmaceuticals, Merck, Actelion, Eisai, and Philips Respironics; and
has served on the speakers’ bureau for Merck and as a board mem-
ber for Jazz Pharmaceuticals. K Babson, S Morris, M Baladi, and D
Hyman are employees of Jazz Pharmaceuticals who, in the course of
their employment, have received stock options exercisable for, and
other stock awards of, ordinary shares of Jazz Pharmaceuticals plc.
D Menno is a former employee of Jazz Pharmaceuticals who, in the
course of this employment, received stock options exercisable for,
and other stock awards of, ordinary shares of Jazz Pharmaceuticals
plc. J Black is a part-­time employee of Jazz Pharmaceuticals and
shareholder of Jazz Pharmaceuticals plc.
P582 | Sleep duration before an E. coli
challenge predicts diarrhea severity during
subsequent infection
J. Mantua1; R. Gutierrez2; S. Isidean2; A. Alcala2; K. Testa2; K.
Talaat3; T.J. Doty1; C. Porter2
1
Walter Reed Army Institute of Research; 2Navy Medical Research
Center, Silver Spring; 3Johns Hopkins School of Medicine, Baltimore,
MD, United States
Objectives/Introduction: The bi-­
directional relationship between
sleep and immune function is well-­established. Sufficient sleep sup-
ports immune health and can increase vaccine efficacy. Conversely,
sickness can disturb sleep quality, which can delay recovery and
waking functioning. However, the bi-­
directional relationship be-
tween sleep and infectious diarrhea, the leading infectious disease
threat to deployed military populations (and a common illness for
non-­military travelers), has not been studied. We assessed the bi-­
directional relationship between sleep and enteric disease utilizing
data from a recently-­completed controlled human infection model
(CHIM) for enterotoxigenic Escherichia coli (ETEC) strain B7A.
Methods: During a CHIM assessing the efficacy of an immunopro-
phylactic targeting ETEC (NCT03040687), we measured sleep via
actigraphy over an 8-­
day inpatient period. Participants ingested
prophylaxis 3 times/day during study days -­2 and -­1 and were chal-
lenged with ETEC on day 0. We hypothesized better sleep pre-­
challenge would reduce risk of disease following challenge (assessed
using linear regression). We also hypothesized total sleep time (TST)
and sleep efficiency (SE) following challenge would be lower/poorer
than baseline (assessed using paired t-­test).
Results: Among 59 participants (aged 34.4 ± 8.1 yrs, 64% male),
longer TST the night preceding ETEC challenge was associated
with lower total diarrhea volume throughout the course of sick-
ness (B = -­3.13, p = 0.001) and fewer overall sickness symptoms
(B = -­0.005, p = 0.03). SE was slightly poorer following challenge (78
vs. 76%; t (55)  = 2.2, p = 0.03), but there was no significant change in
TST, potentially due to low TST pre-­challenge (316 vs. 329 minutes;
p = 0.12).
Conclusions: These results suggest acute sleep loss prior to an en-
teric immune challenge may lead to more severe symptoms during
illness. These results – in aggregation with previous work on sleep
and vaccines – suggest travelers (either military or civilian) should
increase sleep prior to traveling to an area with a high risk for infec-
tious enteric disease.
Disclosure: Nothing to disclose.
ABSTRACTS
P583 | Effects of home confinement due to
COVID-­19 pandemic on sleep-­wake patterns in
young adults from Santiago, Chile
C. Algarin1; O. Rojas1; B. Lozoff2; K. Leyva1; P. Peirano1
1 of disrupting SWS via sleep-­stage specific CPAP withdrawal with or
Sleep and Neurofunctional Laboratory, Institute of Food and
2 without supplemental oxygen in known OSA to create conditions of
Technology (INTA), University of Chile, Santiago, Chile; Department
of Pediatrics and Communicable Disease, University of Michigan, Ann
Arbor, MI, United States
Objectives/Introduction: The ongoing COVID-­
19 pandemic has
caused highly stressful circumstances for people all over the globe.
One of the main methods to avoid being infected is home confine-
ment. Despite this preventive measure, studies show that natural
disasters can lead to health problems, including sleep disturbances.
The objective of this work is to assess whether sleep-­wake patterns
changed after two months of home confinement due to COVID-­19
pandemic in a sample of Chilean young adults.
Methods: Participants were part of an infancy preventive trial and fol-
low-­up study, 59 % were females, mean age 24 years. Each subject com-
pleted the same sleep questionnaire before and during the quarantine.
Sleep items of interest were nighttime sleep onset (SO), sleep latency
(SL), nocturnal awakenings (NA), feeling level of rested sleep (FLRS),
wake-­up time WUT), daytime somnolence (DS) and tiredness (DT).
Results: Compared to the period before the COVID-­19, in the home
confinement, we found longer sleep latency (56 vs. 40 min, p < 0.05),
higher NA (2.8 vs. 2.5, p < 0.01), reduced FRSL (2.1 vs. 2.6, p < 0.01),
later WUT (9:22 ± 2:00 vs. 8:20 ± 1:52 am, p < 0.05),
Conclusions: A group of Chilean young adults, taking part in a study of
sleep, showed changes in SWP after two month of home confinement
due to COVID-­19. Our results are consistent with less consolidated
nighttime sleep and reduced daytime feeling of rested sleep. Further,
they are consistent with altered SWP reported in post-­traumatic stress
disorder patients. (Supported partially by NIH R01 HD33487 grant).
Disclosure: Nothing to disclose.
P584 | Selective CPAP withdrawal with
supplemental oxygen during slow wave sleep as
a method of dissociating sleep fragmentation and
intermittent hypoxia related sleep disruption in OSA
A.E. Mullins; A. Parekh; K. Kam; B. Castillo; Z.J. Roberts; J.Z.
Bronstein; A.M. Mooney; D.M. Rapoport; I. Ayappa; A.W.
Varga
Icahn School of Medicine at Mount Sinai, New York, NY, United States
Objectives/Introduction: Obstructive sleep apnea (OSA) is thought
to impair memory processing and increase expression of amyloid -­β
(Aβ) and risk for Alzheimer's disease (AD). Given evidence that slow
wave sleep (SWS) is important in both memory and Aβ metabolism,
|
      349 of 356
a better understanding of the mechanisms by which OSA impacts
memory and risk for AD can stem from evaluating the role of disrup-
tion of SWS specifically and, when such disruption occurs through
OSA, from evaluating the individual contributions of sleep fragmen-
tation (SF) and intermittent hypoxia (IH). Here, we assess the effect
SF with and without IH.
Methods: We recruited 23 patients (7F, age 50 ± 12 yrs) with moderate-­
to-­severe OSA (AHI4% > 20/hour) treated and adherent to CPAP.
Participants spent 3 separate nights in the lab under 3 conditions:
1) consolidated sleep with CPAP held at therapeutic pressure
(CPAP);
2) CPAP withdrawn exclusively in SWS (SWS-OSA) and
3) CPAP withdrawn exclusively in SWS with simultaneous addition
of supplemental oxygen (SWS-OSA+O2).
One-­way ANOVAs and Tukey post hoc tests were conducted to
compare measures of OSA severity (AHI4%), SF (arousals) and IH
(SpO2 desaturation burden as % Hemoglobin (Hb) saturation/minute
of SWS) during SWS according to condition, α = 0.05.
Results: Compared to the therapeutic CPAP condition, OSA severity
measures during SWS were significantly higher during both SWS-OSA
and SWS-OSA+O2 conditions (AHI4%: CPAP = 0.2/hr, SWS-OSA = 19.5/
hr, SWS-OSA+O2 = 16.3/hr, p < 0.00001). Measures of SF during SWS
were also significantly higher during both SWS-OSA and SWS-OSA+O2
conditions compared to the CPAP condition (Arousals: SWS-OSA = 11.5/
hr, SWS-OSA-O2 = 11.1/hr, CPAP = 1.5/hr, p < 0.00001). There were
no significant differences between the SWS-OSA and SWS-OSA+O2
conditions for OSA severity or SF measures. However, measures of
IH during SWS were significantly reduced during the SWS-OSA+O2
condition compared to SWS-OSA (SpO2 desaturation burden: SWS-­
OSA+O2 = 671%Hb s/min, SWS-­OSA = 1277%Hb s/min, p = 0.01).
Conclusions: Sleep-­s tage specific CPAP withdrawal is an effective
model for inducing sleep fragmentation and intermittent hypoxia
associated with OSA. The simultaneous addition of supplemental
oxygen during CPAP withdrawal results in significantly less severe
oxygen desaturation during the induced respiratory events in SWS.
Disclosure: Nothing to disclose.
P585 | A psychological view on the
effectiveness of psychosocial interventions on
positive airway pressure treatment adherence
and sleep quality in patients with obstructive
sleep apnea
M. Bertrand; I. Boutin; C. Bastien; A. Vallières
Psychology, Laval University, Quebec, QC, Canada
Objectives/Introduction: Positive airway pressure treatment (PAP) is
the gold-­standard for obstructive sleep apnea syndrome (OSAS). PAP
 |
350 of 356       ABSTRACTS
is highly effective, but its issue lays in poor adherence rates caused by
its invasive nature and related stigma. In accordance with a biopsycho-
social model of PAP adherence, psychosocial interventions have been
implemented to alleviate the problematic levels of adherence with
promising results. As the amount of psychosocial interventions grows
the need to systematically evaluate their effectiveness has emerged.
This study aims to identify psychosocial interventions used to increase
PAP adherence, to compile available data on their effectiveness. A sec-
ond objective was to evaluate the interventions impact on sleep quality.
Methods: We included experimental and quasi-­experimental studies
testing psychosocial interventions (excluding educational only inter-
ventions) that aimed to increase PAP adherence in adult patient with
obstructive sleep apnea vs no intervention or control group. Studies
published in English and French between 1980 and September 2019
were included through a literature search in PsycINFO, MEDLINE,
COCHRANE, EMBASE, CINAHL and Web of Science. Risk of bias
and methodological quality was assessed using the Joanna Briggs
Institute Critical Appraisal Tools.
Results: 14 studies were included involving 1,923 participants, six
trials tested a motivational intervention, three trials tested a cogni-
tive behavioral intervention and the five others tested one of the fol-
lowing: relaxation, exposition therapy, phone coaching, audiotape,
or stage-­matched intervention. Twelve studies reported a positive
effect of the intervention on PAP adherence, while two reported no
effect. Due to lack of sleep quality measures in the included stud-
ies, it was impossible to achieve the second objective. Reasons for
interventions effectiveness were pooled into 5 categories: the im-
portance of choosing an appropriate intervention for the patient, the
timing of the intervention, the patient's characteristics, the charac-
teristics of the therapist and the intervention's adaptability.
Conclusions: The current review raises a significant gap between the
biomedical and psychosocial domains. In fact, even in a psychosocial
intervention study, the results interpretation revolves around bio-
medical models and very little consideration is given to psychosocial
models. Our findings demonstrate the importance of examining the
relationship between psychosocial variables and PAP adherence to
better tailor interventions to increase PAP adherence.
Disclosure: Nothing to disclose.
P586 | Emotion coping strategy and sleep-­
related beliefs and attitudes are associated with
objective sleep problems in young insomnia
patients
O. Ballot1; Y. Daviaux2; H. Ivers1; J.A. Micoulaud-Franchi2; S.
Bioulac2; C.M. Morin1; P. Philipp2; E. Altena2
1
Laval University, Quebec, QC, Canada; 2Bordeaux University,
Bordeaux, France
Objectives/Introduction: Though insomnia is associated with emo-
tion regulation difficulties, little is known about how such symptoms
contribute to objective sleep disturbances. We aimed to explore this
relationship in young adults with and without insomnia, to possibly
adapt treatment specifically focused on emotion regulation in this
age group.
Methods: Self-­report tests of insomnia and its comorbid symptoms
(Pittsburgh Sleep Quality Index (PSQ-­I), Insomnia Severity Index
(ISI), Beck Depression Inventory (BDI) amongst others) were admin-
istered to 20 young adults with DSM-­5 diagnosed insomnia (aged
27.7 ± 8.6 years) and 20 age-­matched individuals (26.7 ± 7.0) with-
out insomnia. 10-­days actigraphy served to register objective sleep
data, recording total sleep time (TST), sleep onset latency (SOL) and
sleep efficiency (SE). Sleep-­
related thoughts and emotions (STE)
were measured through the Ford Insomnia Response to Stress Test
(FIRST), Dysfunctional Beliefs and Attitudes about Sleep (DBAS-­
16), Presleep State Arousal Scale (PSAS) and the Thought Control
Questionnaire for Insomnia (TCQI). Emotion coping strategies
(ECS) were measured through the Coping Inventory for Stressful
Situations (CISS) and the Difficulties in Emotion Regulation Scale
(DERS). T-­tests were conducted for sample characterization, then to
select those variables on ECS and STE (independent variables) to be
entered in the multivariate analyses of variance (MANOVA), analyz-
ing their effect on objective sleep (dependent variable) as a main
factor as well as separate effects on SOL, TST and SE.
Results: Next to elevated insomnia symptom scores, insomnia par-
ticipants had higher scores on STE (FIRST, PSAS-­subscale ‘cognitive’,
DBAS-­16, TCQI-­subscales ‘cognitive’ and ‘social’) and ECS (CISS -­
subscale ‘emotion’ and DERS-­subscale ‘aware’). Results from the
MANOVA showed that from these variables, CISS -­subscale ‘emo-
tion’ (F (3, 30)  = 3.95; p = 0.002) and DBAS-­16 (F (3, 30)  = 4.30;
p = 0.012) were associated with worse objective sleep, particularly
driven by effects on sleep efficiency and sleep onset latency.
Conclusions: The results show that emotion coping strategies after a
stressful event and dysfunctional sleep-­related beliefs and attitudes
in particular affect objective sleep in insomnia, which can lead to
treatment adaptations of young insomnia patients
Disclosure: Nothing to disclose.
P587 | The mediating role of arousal and hot
flashes between the daily stress and sleep in
menopausal women with and without insomnia
O. Ballot; H. Ivers; C. Morin
Laval University, Quebec, QC, Canada
Objectives/Introduction: Sleep disturbances become common dur-
ing menopause. Many psycho-­physiological factors increase the risk
of developing insomnia, but the mechanisms responsible for meno-
pausal insomnia are still not understood. This study investigated the
relationship of acute stress-­induced arousal and hot flashes with in-
somnia in menopausal women.
ABSTRACTS
Methods: 63 peri and postmenopausal women (± 51 years old) were
grouped in one of three conditions: good sleeper (n = 20), with pre-
morbid (n = 21) or recent onset (n = 22) insomnia. Women with in-
somnia disorder met DSM-­5 criteria and the onset of their insomnia
preceded (premorbid;  ± 17 years) or coincided (recent;  ± 2.5 years)
with the menopausal transition (± 2.5 years). All participants com-
pleted Daytime Stress Inventory (DSI), Presleep Arousal Scale (PSAS—
subscale cognitive and somatic) and night hot flashes diary (HF).
Other variables included bedtime salivary cortisol and wake after
sleep onset (WASO) derived from actigraphy and sleep diary. Data
were collected during a one-­week period. A multilevel mediation
model was performed for each group using two dependent variables
(subjective and objective WASO), one independent variable (DSI)
and four mediators (HF, PSAS, and cortisol).
Results: Mediation analyses revealed different pattern of results
between stress and subjective sleep according to three groups. For
good sleepers, a direct effect was observed between DSI and WASO
(p = 0.001). Night HF were also a mediator between DSI and WASO
in good sleepers (p = 0.047). For premorbid insomnia group, two indi-
rect effects were found between DSI and WASO, via cognitive PSAS
(p = 0.034) and night HF (p = 0.041). For recent insomnia group, no
indirect effect was found despite significant associations between
HF and WASO (p < 0.001), DSI and cognitive PSAS (p = 0.009), and
cognitive PSAS and WASO (p = 0.009). No mediating effect was ob-
served with the other variables.
Conclusions: Although results have shown a relationship between
stress, cognitive pre-­sleep arousal, night hot flashes and insomnia,
it is not clear that menopause itself produces or exacerbates sleep
disorders. Further studies are needed to improve our understanding
of the link between menopause and insomnia in order to design ef-
fective treatments for this at-­risk population.
Disclosure: Nothing to disclose.
P588 | Psychophysiological responses to an
acute experimental stressor in adolescent boys
and girls with and without insomnia
M. de Zambotti; D. Yuksel; L. Volpe; D. Prouty; Q. Lee; R.
Wang; T. Dulai; S. Claudatos; N. Arra; F. Baker
SRI International, Menlo Park, CA, United States
Objectives/Introduction: Insomnia frequently emerges in adoles-
cence, with girls being at higher risk for developing the disorder. This
study aims at investigating stress reactivity, a key factor implicated
in the pathophysiology of insomnia, in a sample of healthy adoles-
cents, as a function of sex and insomnia status.
Methods: Forty-­seven adolescents (16–19 years old, 28 girls), eight-
een of whom presented clinical DSM-­5 insomnia symptoms, took
part in the Trier Social Stress Test (TSST). The TSST is a standardized
laboratory paradigm designed to induce psychophysiological stress
via delivery of a 5-­min speech and performance of a 5-­min mental
|
      351 of 356
arithmetic task in front of a socially evaluative audience. Perceived
stress, systolic blood pressure (SBP) measured with sphygmoma-
nometer, and heart rate (HR) measured via validated HR monitor
chest strap, were analyzed before (baseline), during and after (recov-
ery) the stress task.
Results: At baseline, girls compared to boys had reduced SBP and
elevated HR (p < 0.05). All participants reported greater stress in
anticipation and right after the stress task, compared to baseline and
recovery (p < 0.05); Perceived stress was similar in insomnia and con-
trol boys and girls. SBP and HR rose significantly in response to the
task in both insomnia and non-­insomnia boys and girls (p < 0.05). HR
task reactivity did not differ between girls with (+47.7% HR increase)
and without (+35.8% HR increase) insomnia, while it was blunted in
boys with (+23.2%) compared to boys without (+40.2%) insomnia
(p < 0.05). Also, HR stress reactivity was greater in insomnia girls
vs. insomnia boys (p < 0.05). Trait measures of perceived stress ex-
periences highlighted a greater amount of stress related to school
performance in boys and girls with insomnia compared to controls,
and greater concerns for the future in insomnia girls compared to
non-­insomnia girls and boys with and without insomnia (p < 0.05).
Conclusions: Our findings highlight complex interactions between
sex and insomnia status in the physiological response to acute ex-
perimental stress. A better understanding is needed of the physi-
ological perturbations of insomnia in adolescence and factors that
could contribute to the vulnerability for insomnia, such as female sex
and stress reactivity, to improve the characterization and manage-
ment of the disorder.
Disclosure: This study was supported by the National Heart, Lung
and Blood Institute (NHLBI) grant R01 HL139652 (to MdZ). The con-
tent is solely the responsibility of the authors and does not neces-
sarily represent the official views the National Institutes of Health.
Authors declared no conflict of interest related to the current work.
MdZ and FCB have received research funding unrelated to this
work from Ebb Therapeutics Inc., Fitbit Inc., International Flavors &
Fragrances Inc., and Noctrix Health, Inc.
P589 | Sleep recovery from acute to chronic
moderate-­severe traumatic brain injury is
associated with long-­term functional cognitive
outcomes
E. Sanchez1; S. Van Der Maren1; C. Duclos2; H. El-Khatib1; C.
Arbour1; A.-A. Baril3; H. Blais1; J. Carrier1; N. Gosselin1
1
Université de Montréal; 2McGill University, Montréal, QC, Canada;
3
Boston University School of Medicine, Boston, MA, United States
Objectives/Introduction: We previously showed that sleep, includ-
ing slow waves and spindles, is severely disrupted in the acute stage
of moderate to severe traumatic brain injury (TBI) before recover-
ing to normal levels in the chronic stage, when compared to either
severe orthopedic injury patients in a similar hospital environment
 |
352 of 356       ABSTRACTS
or healthy controls. Here, we investigated how sleep oscillations’
disruption and their recovery over time is associated with long-­term
functional cognitive outcomes.
Methods: A subset of the moderate to severe TBI cohort was tested
with whole-­night polysomnography in both the acute stage (after ICU
discharge, before hospital discharge) and chronic stage (at least one
year following the injury) of their injury (n = 9, age = 29.7 ± 13.8y). A
full neuropsychological battery of tests was also conducted at the
chronic stage. Slow wave and spindle characteristics were quanti-
fied over NREM sleep for the first three sleep cycles for both stages.
Associations between acute sleep oscillations, sleep oscillations re-
covery over time, and neuropsychological outcomes were assessed
using Pearson correlations.
Results: Higher acute slow wave density and bigger subsequent
decline over time to normal levels correlated with better scores at
follow-­up in memory encoding, more precisely with the Hopkins
Verbal Learning test (r = 0.68 to 0.71, p = 0.03 to 0.04). Similarly,
higher acute spindle density correlated with better scores at follow-
­up in executive functioning, including the Trail-­Making Test part B
(r = 0.78 to 0.89, p = 0.01 to 0.002) and the Tower of London test
(r = 0.68 to 0.91, p = 0.04 to 0.001). Neither age nor injury severity
correlated with these variables.
Conclusions: We show here that slow waves, which are known to be
involved in synaptic plasticity behind learning and memory, were as-
sociated with long-­term cognitive outcomes in learning and memory,
and that spindles, which are known to be involved in cognitive func-
tioning, were associated with long-­term cognitive outcomes in ex-
ecutive functioning. These results highlight the need to understand,
accommodate, and treat sleep in brain-­injured patients as soon as
possible in the recovery process.
Disclosure: Nothing to disclose.
P590 | Circadian preference, social jetlag and
socio-­emotional functioning of gifted children
L. Bastien1,2; R. Théoret1,2; R. Godbout1,3
1
Sleep Laboratory & Clinic, Hôpital en Santé Mentale Rivière-­des-­
Prairies, CIUSSS du Nord-­de l’Île-­de-­Montréal; 2Department of
Psychology, Université de Montréal, Montreal; 3Department of
Psychiatry, Université de Montréal, Montréal, QC, Canada
Objectives/Introduction: Circadian preference (an individual's time-­
of-­day preference for bedtime and rise time, and to perform physical
and intellectual activities) has been associated with socio-­emotional
functioning in neurotypically developing children. Evening prefer-
ence is related to behavioral problems, low school performance and
social jetlag (i.e., mismatch between preferred sleep/wake schedule
and daytime schedules imposed by work-­or schooldays). Inversely,
morning type children are reported to have healthier behaviors and
less discrepancy between schooldays and weekends sleep sched-
ules. Gifted children are known to have atypical sleep patterns and
socio-­emotional issues. The aim of this study was to investigate the
link between circadian preference, social jetlag and socio-­emotional
outcomes in gifted children. The hypothesis was that a majority of
gifted children would be morning types and that would correlate
with more socio-­emotional symptoms.
Methods: Thirty-­two gifted children (24 boys, mean age = 9.60,
SD = 1.79) were studied. Giftedness was identified by an experi-
enced clinician according to Renzulli´s criteria. Sleep was evaluated
with actigraphy for two weeks. Social jetlag was measured as the
difference between the midpoint of sleep during schooldays and
weekends. Circadian preference was measured by the Morningness-­
Eveningess Scale for Children (MESC). Socio-­emotional symptoms
were assessed using the Behavioral Assessment System for Children
(BASC, 3rd edition). Pearson correlation and linear regression analy-
sis were used to evaluate associations and predictive value of gifted
children's circadian preference on socio-­emotional outcomes.
Results: Gifted children were mostly morning types (67.7%;
MESC  ≥  28); 32.3% reported having no circadian preference and
none were evening types (MESC  ≤  20). Morning type preference
was predictive of less socio-­emotional problems (negative emotiv-
ity, anger control, abnormalities, somatisation ; β = -­1.62 to -­1.09,
p < 0.04). Circadian preference was positively associated with so-
cial jetlag (r = 0.64, p < 0.001), so that largest differences between
schooldays and weekends sleep schedules were seen in morning
types.
Conclusions: A majority of gifted children were morning types
and this was predictive of healthier socio-­emotional functioning.
Surprisingly, however, morning preference was also associated with
sleeping earlier on weekends (social jetlag), which suggests that they
recover from busy schooldays schedules during weekends.
Disclosure: Nothing to disclose.
P591 | Influence of Toddlers sleep on parental
-­sleep, -­emotional competence, and -­sleep
related cognitions -­Do differences between
mothers and fathers exist?
F. Lollies1; A.A. Schlarb2
1
Bielefeld University; 2Psychology, Clinical Psychology and
Intervention, Bielefeld University, Bielefeld, Germany
Objectives/Introduction: Toddlers sleep is one of the major causes
of distress in families. In various studies it was postulated, that there
might be differences in the appraisal of toddlers sleep between
mothers and fathers. However, there is evidence for a strong asso-
ciation between infants sleep quality and maternal emotional com-
petence and resilience, but no former study assessed this association
in fathers. Furthermore, especial the emotional well-­being might be
associated to cognitions related to problematic toddlers’ sleep be-
havior. The objective of this study was to explore the interaction
between toddlers’ sleep, and respectively maternal and paternal
ABSTRACTS
subjective sleep measures, toddler sleep related cognitions, and
emotional competence.
Methods: The Test-­
battery contained the Child Sleep Habits
Questionnaire (CSHA) to assess sleep problems of the child. Parental
sleep was assessed by the Pittsburgh Sleep Quality Index (PSQI).
Additionally, the Infant Sleep Vignettes Interpretation Scale (ISVI)
was implemented to gather parental sleep-­related cognitions, and
the Self-­A ssessment of Emotional Competencies (SAEC) completed
the survey. A multivariate analysis of covariance (MANCOVA) to
analyze group differences between good sleeping children, problem
sleeper, and parental variables is calculated. For further multivariable
comparison between parental variables of good and problem sleep-
ers a stepwise discriminant analysis with group (good vs. problem
sleepers; mother vs. father) as independent variable and parental
sleep parameters, parental sleep-­related cognitions, and social com-
petences as the discriminating variables is implemented. Significant
results (p < 0.05) and effect sizes according to Cohen are described.
Results: The study is ongoing due to the CORONA-­crisis. As parents
completed 2 questionnaires independently, The current sample con-
sists of 198 parents (99 fathers and 99 mothers), representing data
of 99 children (44.4% female) aged 4 to 68 months (M = 27.4).
Conclusions: According to former research we expect significant
group differences regarding the child's sleep measures and parental
sleep-­related cognitions. However, the analysis of the association of
the child's sleep and parental emotional competence is explorative
and results are suspenseful expected.
Disclosure: Nothing to disclose.
P592 | Project of the trial of effectiveness and
cost-­effectiveness of internet-­based cognitive
behavioral therapy for insomnia
P. Pchelina1; T. Berger1; M. Poluektov2; T. Krieger1; S. Duss1;
C. Bassetti1,2
1
University of Bern, Bern, Switzerland; 2I.M. Sechenov First Moscow
State Medical University, Moscow, Russian Federation
Objectives/Introduction: Chronic insomnia being widespread and
high resistant to the treatment disorder however has a big poten-
tial to be managed with internet-­delivered techniques. The balance
between effectiveness and cost-­effectiveness of this approach is a
subject of many researches. The proposed study aims to investigate
clinical effectiveness and cost-­effectiveness of the internet-­based
cognitive behavioral therapy for insomnia (iCBT-­I) and to determine
predictors of its effect
Methods: We propose the two-­arm randomised non-­blinded con-
trolled trial with care as usual (CAU) as control condition. Participants
will be recruited in routine medical care. Both arms will get prescribed
treatment and investigation group will additionally get access to the
iCBT-­I program for 2 months. The investigated iCBT-­I program con-
sists of interactive educational material divided into eight modules
|
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providing the rationale for the main techniques of cognitive behav-
ioral therapy for insomnia with the opportunity to contact a special-
ist (guidance on request). The primary outcome measure is insomnia
severity. Secondary outcomes are subjective sleep characteristics,
life quality, fatigue, daytime sleepiness, affective disorders, dysfunc-
tional thinking, sleep hygiene, associated costs.
Results: Sample size was calculated to be equal to 110 for the total
sample, aiming to detect effect size equal 0.35 with α-­level of 0.05
and a power of 0.95. The effect size was chosen since CAU being
an active alternative treatment may decrease between-­group out-
come differences and a smaller effect size is irrelevant from a clinical
point. Treatment effect will be evaluated by mixed-­model repeated-­
measures analysis where the comparisons of outcome measures will
include time as within-­group variable and the condition as between-­
group variable. Regression analysis will be conducted for the baseline
variables potentially predicting, mediating and moderating effect.
Conclusions: The proposed study is one of the first iCBT-­I studies
to be conducted in clinical settings which is important for precise
determining target group and exclusion of interfering health prob-
lems. Furthermore, this approach along with the CAU in both arms
let us recreate clinical situation. Results will give new information
about added value of the iCBT-­I in routine care and about the type
of patients who may benefit from it
Acknowledgements: The work was supported by ESKAS Swiss
Government Excellence scholarship 2019–2020
Disclosure: The iCBT-­I program was developed by the authors for
research purposes, but is delivered via a web-­based software devel-
oped by OOO Техномаркт Ltd, a Russian private company. Pchelina
P. is working as an external consultant in the project. managed by
this company This project aims medical counseling of shift work em-
ployees and has no connection to this manuscript. Other authors
declare no competing interests.
P593 | Sleep schedule and insomnia risk in
computer technician students at Mare de Déu de
la Mercè Institute in Barcelona
B. Garcia Parra
Neurology Department, Clinical Neurophysiology Section, Bellvitge
University Hospital, L'Hospitalet de Llobregat. Barcelona, Spain
Objectives/Introduction: Evaluating sleep schedule and insom-
nia risk in computer technician (CT) students at Mare de Déu de la
Mercè Institute in Barcelona.
Adolescents are a population in risk of insomnia because they are
usually more active during the evening but they have morning aca-
demic schedules. This may involve attending to school with sleep
deprivation, which may limit the acquisition of knowledge. In addi-
tion, CT students regularly use electronic devices with the conse-
quent risk of further delaying their sleep schedule.
 |
354 of 356       ABSTRACTS
Methods: The CT students described their sleep schedule and com-
pleted Insomnia Severity Index (ISI). They were twenty four men
aged between 17 and 27 years old. The ISI is a 7 item self report
questionnaire to assess insomnia. The dimensions evaluated are av-
erage severity of sleep onset, sleep maintenance, and early morn-
ing awakening problems (0–12), average sleep dissatisfaction (0–4),
average interference of sleep difficulties with daytime functioning
(0–4), average noticeability of sleep problems by others (0–4) and
average distress caused by the sleep difficulties (0–4). A 5-­point
Likert scale is used to rate each item (0 = no problem; 4 = severe
problem), yielding a total score ranging from 0 to 28. The total score
is interpreted as absence of insomnia (0–7); sub-­threshold insomnia
(8–14); moderate insomnia (15–21); and severe insomnia (22–28).
Results: CT students had an average of 6,7 (5–8) hours of sleep in
school days and an average of 9 (4–12) hours of sleep in free days.
The average severity of sleep onset, sleep maintenance, and early
morning awakening problems 5,2; average sleep dissatisfaction 3,3;
average interference of sleep difficulties with daytime functioning
2,7; average noticeability of sleep problems by others 1,8; average
distress caused by the sleep difficulties 2,1. In summary an average
ISI total score of 15,1. They had moderate insomnia according to the
questionnaire results.
Conclusions: CT students are a risk group for developing insomnia,
because they are adolescents and they also have to use electronic
devices to acquire necessary knowledge for their future profession.
Educating these students with healthy sleeping habits can prevent
the development of sleep disorders.
Disclosure: Nothing to disclose.
P594 | Benzodiazepine receptor agonists
prescription for insomnia in a geriatric population
of hospitalised patients in a geriatric psychiatric
unit in Switzerland
M. Dalmau i Ribas; E. Gillès dePélichy
Psychiatry, Centre Hospitalier Universitaire Vaudois, Prangins,
Switzerland
Objectives/Introduction: Benzodiazepine Receptor Agonists
(BZRA) are widely prescribed among the older adults as a treatment
for insomnia, in spite of this group being at highest risk of adverse
effects including falls, fractures, cognitive deficits and death. The
goal of this study is to describe the BZRA prescription trends in a
geriatric population of hospitalised patients in a geriatric psychiatric
unit in Switzerland.
Methods: The study is a retrospective observational study based
on medical records. All admitted patients in the psychogeriatric unit
of Hôpital Psychiatrique de Prangins between the 1st of January
2020 and the 31st of March 2020 were screened for eligibility, and
those ≥ 65 years were included in the study. For all included patients,
age, sex, presence or absence of BZRA at the time of admission,
cognitive status and living destination were recorded. The main out-
come of the study is the percentage of patients receiving BZRA at the
time of admission. Secondary outcomes include association between
presence or absence of BZRA and age, sex, cognitive status and living
destination respectively, which is calculated using odds ratio.
Results: 32 patients were included in the study. 65% were women
and the mean age was 80.5 years (SD 8.2). 28% of patients pre-
sented with BZRA treatment at admission, with the most common
drugs being Clonazepam (33%) and Zolpidem (22%). 97% of patients
included in the study presented cognitive impairment, and 78% of
the patients were sent to a nursing home after the hospitalisation.
Women were prescribed with BZRA treatment more often than
men (OR 1.8, CI 0.3–10.9), patients aged 75–84 more often than the
younger ones (OR 1.5, CI 0.22–11.9), and patients being sent to a
nursing home more often than patients going home after discharge
(OR 0.63, CI 0.05–8.25), but the association was found to be non
significant.
Conclusions: BZRA prescription is very frequent among the older
population of hospitalised psychiatric patients. Our study did not
have enough statistical power to assess the association between
BZRA prescription and age, sex, cognitive status or destination after
hospitalisation. Bigger studies should be carried out to study these
associations.
Disclosure: Nothing to disclose.
P595 | Association of REM sleep with body fat
distribution in patients with insomnia disorder
R. Göder1; C. Blome1; M. Wittich1; S. Weinhold1; J.
Lechinger1; H. Drews1; M. Both1; W. Braun2; M. Müller2; A.
Bosy-Westphal2
1
University Hospital Schleswig-­Holstein; 2University of Kiel, Kiel,
Germany
Objectives/Introduction: Increasing epidemiological evidence
indicates an impact of sleep duration and sleep quality on the de-
velopment of overweight. Only a few studies have used objective
measurements to investigate the relationship between sleep and
body fat distribution.
Methods: We investigated nine patients with insomnia disorder
(mean age 44 years ± 12 years; mean BMI 23.2 ± 3.8; all women).
All participants underwent polysomnography in the sleep laboratory
according to AASM criteria. Fat mass and fat-­free mass were meas-
ured by Air Displacement Plethysmography (ADP). Subcutaneous
adipose tissue and visceral adipose tissue were assessed by mag-
netic resonance imaging (abdominal MRI).
Results: Mean sleep duration was 379 ± 38 minutes and mean REM
sleep duration was 64 ± 21 minutes. Mean sleep efficiency was 87 ± 7%.
Mean fat mass was 21.4 ± 6.9 kg and mean fat free mass was
45.2 ± 4.9 kg. Mean visceral adipose tissue was 0.5 ± 0.3 l and mean
subcutaneous adipose tissue was 13.9 ± 4.4 l.
ABSTRACTS
The main results were significant negative partial correlations (con-
trolled for age) of subcutaneous (r = -­0.7) and visceral (r = -­0.9) adi-
pose tissue with REM-­sleep duration but not with Non-­REM-­sleep
parameters.
Conclusions: Lower REM sleep duration was associated with more
visceral or subcutaneous adipose tissue in female patients with in-
somnia disorder.
Disclosure: Nothing to disclose.
P596 | Sleep after concussion: long-­term
monitoring in children and adolescents in a
home-­setting
J. Albrecht1; S. Altermatt1; B. Brotschi1; C. Baumann2; M.L.
Ferster3; W. Karlen3; R. Huber1,4
1
University Children's Hospital Zurich; 2University Hospital Zurich;
3
ETH Zurich; 4Psychiatric Hospital of the University of Zurich, Zurich,
Switzerland
Objectives/Introduction: Until reaching adulthood, every third child
or adolescent experiences a concussion. While sleep problems and
fatigue are amongst the most common post-­concussive symptoms
(PCS), there is increasing evidence that sleep plays an important role
in the post-­concussion recovery process. In most cases, PCS are
transient, but in a subset, they persist throughout the chronic phase.
PCS are also linked to cognitive performance, which is affected in
about 50% of the patients. Particularly in children, there is very lim-
ited objective sleep data available. Thus, in order to gain valuable
insights into the recovery process, we aim to investigate sleep during
the acute phase after a concussion in children and adolescents.
Methods: As a means to monitor sleep with minimal burden for the
patients, we use the MHSL-­SleepBand device, a mobile electroen-
cephalography (EEG) device developed at ETH Zurich. Patients use
the mobile device at home without supervision for multiple consecu-
tive nights.
Results: We successfully measured three patients so far (aged
9–11 years) for five to seven nights starting on the day of hospital
discharge around one day after concussion. Patients were able to
apply the device by themselves or with their parents’ help with high
compliance. The EEG data is of good quality, allowing for conven-
tional sleep staging and analyses. Across all complete nights (n = 12),
mean sleep efficiency was 96.59% (range: 93.16 -­99.15%), which
was paralleled by subjective reports of good sleep quality.
Conclusions: Our preliminary results show good feasibility of sleep
EEG recording in a home-­setting over multiple nights in this popula-
tion. We will further pursue this approach to investigate how sleep
in the acute phase after a concussion relates to recovery from a con-
cussion in children and adolescents.
Disclosure: Nothing to disclose.
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P597 | Examining the efficacy of
pharmacological interventions for sleep and
circadian rhythm disturbance in bipolar disorder:
a systematic review
D. Kim1; M. de Andres Crespo1; L. Bisdounis2,3; K.
Saunders3,4; N.M. McGowan3,4
1
Clinical Medical School, Medical Sciences Division, University of
Oxford; 2Nuffield Department of Clinical Neurosciences, University
of Oxford/Sleep & Circadian Neuroscience Institute; 3Department of
Psychiatry, University of Oxford; 4Warneford Hospital, Oxford Health
NHS Foundation Trust, Oxford, United Kingdom
Objectives/Introduction: Bipolar disorder (BD) is a severe psychi-
atric condition characterised by recurrent episodes of depression
and mania. Insomnia is a feature of both mood states and a potential
precipitating factor for relapse. Furthermore, circadian rhythm dis-
ruption has been highlighted in BD. Non-­benzodiazepine hypnotic
drugs are a mainstay treatment for insomnia but long-­term use is
contraindicated and little is known about their efficacy for managing
sleep disturbance in BD. While chronobiotic agents, such as mela-
tonin or melatonergic drugs have been recently suggested as novel
treatments for BD their efficacy is also unclear.
Here we present a systematic review on the efficacy of pharmaco-
logical non-­benzodiazepine hypnotic and chronobiotic interventions
to treat sleep and circadian rhythm sleep disturbance in BD patients.
Methods: We conducted a systematic search on AMED, Embase,
MEDLINE and PsycINFO for original studies in English, investigating
the efficacy of non-­benzodiazepine hypnotic and chronobiotic in-
terventions to treat sleep and circadian rhythm disturbance in adult
BD patients. Included studies involved one or more of 14 agents (di-
phenhydramine, doxylamine, melatonin, ramelteon, zolpidem, eszo-
piclone, zaleplon, doxepin, promethazine, agomelatine, zopiclone,
chloral, clomethiazole and suvorexant) that are indicated for sleep
disorders or have a chronobiotic mechanism. Both objective and
subjective measures of sleep and circadian rhythm symptoms were
considered as outcomes for study inclusion.
Results: 3787 publications were identified in the initial search, of
which 162 studies were included after title screening. After abstract
screening, 51 studies were included for full-­text review which led to
a final 8 articles being included. After this stage, we aim to conduct
a narrative synthesis from our findings in the literature. If we find a
sufficient number of studies with similar methodology for a given in-
tervention we will perform a meta-­analysis with the quantitative data.
Conclusions: Though still ongoing, this is the first review of its kind
to examine the treatment of sleep disturbances in bipolar patients
using non-­benzodiazepine hypnotic and chronobiotic interventions.
We aim to critically examine the current evidence in this field of re-
search, in the hope that this may influence clinical guidelines in the
future.
Disclosure: The authors disclose no conflicts of interest. LB is
supported by the Nuffield Department of Clinical Neurosciences
 |
356 of 356       ABSTRACTS
support fund (HMT00230 HM04.01) and by Medical Research
Council Doctoral Training Partnership grant (MR/N013468/1).
KEAS is supported by the NIHR Oxford Health Biomedical Research
Centre.
P598 | Association between sleep duration
and refractive errors: a cohort study on French
preschoolers
A. Rayapoullé1,2; C. Gronfier3; A. Forhan1,4; B. Heude1,4;
M.-A. Charles1,4; S. Plancoulaine1,4
1
U 1153 CRESS – Team EAROH, INSERM, Villejuif; 2Assistance
Publique Hôpitaux de Paris, Paris; 3Lyon Neuroscience Research Center
U1028/UMR5292, Claude Bernard University Lyon 1, Lyon; 4Université
de Paris, Paris, France
Objectives/Introduction: Refractive errors are very common in the
world population, and myopia in particular is rapidly gaining ground
in children and adolescents, leading to global health issues, academic
implications and economic costs. The process of emmetropization
in child development is a multifactorial and active mechanism and
is yet to be fully understood. Light exposure and inner circadian
rhythms are thought to have an important role in this process, which
are known to be both cause and consequence of various sleep hab-
its. Our study aims at assessing the importance of sleep duration in
refractive error development on preschoolers.
Methods: Data were collected through parental auto-­questionnaires
as part of the EDEN birth-­cohort protocol and 1,133 children were en-
listed in our study. Sleep duration was assessed at age 2 and 5 years,
vision problems were assessed at 5 years of age. We performed both
cross sectional and longitudinal logistic regression analyses adjusted
on confounding factors such as age, sex, socio-­economic status, nap
duration, physical activity and daily screen time. Multiple imputations
were performed on missing data for covariates.
Results: At age 5 years, 2% of the children presented myopia, 11.9%
hyperopia and 20.4% were prescribed glasses. Children slept in
means (SD) 11 hrs05 (30 min) per night at age 2 and 10 hrs49 (48 min)
at age 5. In the raw longitudinal analysis, a U-­shaped association was
observed between nocturnal sleep duration at age 2 and eyeglass
prescription at age 5: 2-­year-­old children with nocturnal sleep dura-
tion < 10 h45 and > 11 h30 had a significantly higher risk to have
an eyeglass prescription by the age of 5, whether it was for myopia,
hyperopia or unknown reasons. The relations remained after adjust-
ment while becoming borderline significant. Cross-­sectional analysis
at age 5 and longitudinal subgroup analyses on either myopia or hy-
peropia were not significant.
Conclusions: Sleep duration at age 2 is associated with subsequent
onset of refractive errors in preschoolers from general population.
Results need to be confirmed in cohort with larger sample size.
Disclosure: Nothing to disclose.