Abstract
Introduction
The Psychomotor Vigilance Test (PVT) is a behavioral attention measure widely used to describe sleep loss deficits. Although there are reported differences in PVT performance ...for various demographic groups, no study has examined the relationship between measures on the 10-minute PVT (PVT10) and the 3-minute PVT (PVT3) within sex, age, and body mass index (BMI) groups throughout a highly controlled sleep deprivation study.
Methods
Forty-one healthy adults (mean±SD ages, 33.9±8.9y) participated in a 13-night experiment 2 baseline nights (10h-12h time in bed, TIB) followed by 5 sleep restriction (SR1-5) nights (4h TIB), 4 recovery nights (R1-R4; 12h TIB), and 36h total sleep deprivation (TSD). A neurobehavioral test battery, including the PVT10 and PVT3 was completed every 2h during wakefulness. Repeated measures correlation (rmcorr) compared PVT10 and PVT3 lapses (reaction time RT >355ms PVT3 and >500ms PVT10) and response speed (1/RT) by examining correlations by day (e.g., baseline day 2) and time point (e.g., 1000h-2000h) within sex groups (18 females), within age groups defined by a median split (median=32, range=21-49y), and within BMI groups defined by a median split (median=25, range=17-31).
Results
PVT10 and PVT3 1/RT was significantly correlated at all study days and time points excluding at baseline for the younger group and at R2 for the higher BMI group. PVT10 and PVT3 lapses showed overall lower correlations across the study relative to 1/RT. Lapses were not significantly correlated at baseline for any group, for males across recovery (R1-R4), for the high BMI group at R2-R4, for the older group at R2-R3, or for the younger group at SR5 or R3.
Conclusion
Differentiating participants based on age, sex, or BMI revealed important variation in the relationship between PVT10 and PVT3 measures across the study. Surprisingly, lapses were not significantly correlated at baseline for any demographic group or across recovery for males or the high BMI or older group. Thus, PVT10 and PVT3 lapses may be less comparable in certain populations when well-rested. These findings add to a growing literature suggesting demographic factors may be important factors to consider when evaluating the effects of sleep loss.
Support (if any)
ONR Award N00014-11-1-0361;NIH UL1TR000003;NASA NNX14AN49G and 80NSSC20K0243; NIHR01DK117488
Abstract
Introduction
Polysomnography (PSG) is the gold standard for the diagnosis of obstructive sleep apnea (OSA). Given cost, insurance restrictions and in some cases limited access to sleep ...center testing, the use of home based sleep apnea testing is becoming increasingly more common. A proportion of patients with technically adequate HSAT who are negative end up having significant disease on PSG. The characteristics of patients who are found to have moderate to severe sleep apnea on polysomnogram (PSG) after a negative home sleep apnea test (HSAT) are not known. We aim to phenotype these patients.
Methods
We conducted a retrospective chart review from March 2018 to February 2020. A total of 953 adult patients (18 years old and older) underwent HSAT, 248 tests resulted negative (apnea-hypopnea index <5/h). Out of the negative HSAT, 17 patients had moderate to severe obstructive sleep apnea on PSG. Those were included for analysis. Data on patient characteristics such as age, body mass index (BMI), gender, STOP-BANG, ESS and comorbidities was gathered. Respiratory disturbance index, recording time, flow time, oximetry time on HSAT was recorded. PSG recording time, baseline AHI, supine AHI and non-supine AHI were also noted. Technically inadequate HSAT were excluded from analysis.
Results
The percentage of patients with negative HSAT who were found to have moderate to severe sleep apnea on PSG and were included for analysis was 6.85% (n17). Mean age was 41 years. Mean BMI was 33 kg/m2. Common comorbidities were hypertension (29%), asthma (17.6 %), depression (17.6%), anxiety (11.7%) and reflux (5.9%). Average ESS was 11.7 and STOP-BANG was 3.8. The mean recording time was 477 minutes, flow time 391 minutes and oximetry time was 426 minutes on HSAT. Average PSG recording time was 433 minutes. Average AHI was 24 with supine being 33.2/h and non-supine 17.9/h.
Conclusion
A proportion of patients with negative HSAT have moderate to severe OSA on follow-up polysomnogram. These patients were young, with lower-class obesity, more positional OSA, and no associated complex comorbidities. Re-evaluation of current diagnostic algorithms and further research is needed to phenotype this at-risk group, as first-line PSG may be more cost-effective and efficient.
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Abstract
Introduction
Few studies have examined circadian phase after job loss, an event that upends daily routine. It is common that a daily routine begins with the consumption of breakfast, and ...breakfast behavior may contribute to health status in adults. Therefore, we sought to examine whether a later midpoint of sleep was associated with breakfast skipping among adults whose schedules were no longer dictated by employment.
Methods
Data were obtained from the Assessing Daily Activity Patterns Through Occupational Transitions (ADAPT) study. The sample of 155 participants had involuntarily lost their jobs in the last 90 days. Both cross-sectional and 18-month longitudinal analyses assessed the relationship between sleep midpoint after job loss and current and later breakfast skipping. Assessment periods were 14 days. Sleep was measured via actigraphy, and breakfast skipping was measured via daily diary (1 = had breakfast; 0 = did not have breakfast). The midpoint of sleep was calculated as the circular center based on actigraphy sleep onset and offset times.
Results
The midpoint of sleep at baseline was negatively associated with breakfast consumption at baseline (B = -.09, SE = .02, p = .000). Also, a later midpoint was associated with breakfast skipping over the next 18 months (estimate = -.08; SE = .02; p = .000). Prospective findings remained significant when adjusting for gender, ethnicity, age, perceived stress, body mass index (BMI), education, and reemployment over time. Education (estimate = 14.26, SE = 6.23, p < .05) and BMI (estimate = -.51, SE = .25, p < .05) were the only significant covariates. No other sleep indices predicted breakfast behavior cross-sectionally or prospectively.
Conclusion
Consistent with research in adolescents, unemployed adults with a later circadian phase are more likely to skip breakfast more often. Breakfast skipping was also associated with higher BMI. Taken together, these findings provide support for the future testing of sleep/wake scheduling interventions to modify breakfast skipping and potentially mitigate weight gain after job loss.
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#1R01HL117995-01A1
Here, we aimed to study the effect of adjuvant AOM on weight loss and weight regain during and after a comprehensive lifestyle program including a VLCD/TMR phase, compared to those who were not on ...AOM. Methods: This is a retrospective study of patients with obesity who were enrolled in a VLCD/TMR program (OPTIFAST) at a single site. Baseline characteristic of patients All patients N=206 No AOMs N=139 (67%) AOMs N=67 (33%) P-value Age, years 52.39 (13.05) 52.81 (13.34) 51.86 (12.73) 0.60 Sex, females 139 (67.96%) 97 (69%) 43 (65%) 0.51 BMI, kg/m2 41.71 (7.04) 41.77 (6.88) 41.64 (7.27) 0.90 Baseline weight, kg 117.95 (24.06) 119.13 (24.94) 117.37 (23.69) 0.64 Diabetes, yes 102 (49%) 58 (41%) 44 (66%) 0.001 Behavioral diagnosis at baseline, yes 87 (42.23%) 57 (40%) 30 (45.5%) 0.47 AOM, anti-obesity medications; BMI, Body Mass Index.
Abstract
Background
Few studies have examined the independent and combined relationships of body mass index (BMI) peak and rebound with adiposity, insulin resistance and metabolic risk later in life. ...We used data from Project Viva, a well-characterized birth cohort from Boston with repeated measures of BMI, to help fill this gap.
Methods
Among 1681 children with BMI data from birth to mid childhood, we fitted individual BMI trajectories using mixed-effects models with natural cubic splines and estimated age, and magnitude of BMI, at peak (in infancy) and rebound (in early childhood). We obtained cardiometabolic measures of the children in early adolescence (median 12.9 years) and analysed their associations with the BMI parameters.
Results
After adjusting for potential confounders, age and magnitude at infancy BMI peak were associated with greater adolescent adiposity, and earlier adiposity rebound was strongly associated with greater adiposity, insulin resistance and metabolic risk score independently of BMI peak. Children with a normal timing of BMI peak plus early rebound had an adverse cardiometabolic profile, characterized by higher fat mass index {β 2.2 kg/m2 95% confidence interval (CI) 1.6, 2.9}, trunk fat mass index 1.1 kg/m2 (0.8, 1.5), insulin resistance 0.2 units (0.04, 0.4) and metabolic risk score 0.4 units (0.2, 0.5) compared with children with a normal BMI peak and a normal rebound pattern. Children without a BMI peak (no decline in BMI after the rise in infancy) also had adverse adolescent metabolic profiles.
Conclusions
Early age at BMI rebound is a strong risk factor for cardiometabolic risk, independent of BMI peak. Children with a normal peak-early rebound pattern, or without any BMI decline following infancy, are at greatest risk of adverse cardiometabolic profile in adolescence. Routine monitoring of BMI may help to identify children who are at greatest risk of developing an adverse cardiometabolic profile in later life and who may be targeted for preventive interventions.
Introduction: The cutaneous electrogastrogram (EGG) is a noninvasive technique for measuring gastric myoelectric activity. The size, position and shape of the stomach vary considerably depending on ...body mass index, fed/fasting state and age (Lamart et al, 2013). In this study, we assessed how the placement of EGG electrodes can influence the ability to detect normal gastric slow waves. Methods: Eleven asymptomatic subjects (8M/3F, age 21-77 years) with an average BMI of 26 (range 21.8-36.3) were enrolled. Subjects were excluded if they had any active foregut symptoms on the PAGI-SYM questionnaire. We placed 100 EGG electrodes in a uniform 10x10 grid (2cm x 2cm spacing) on the abdominal wall extending inferiorly from the sternum at the top with reference and ground electrodes on the subjects right side. The locations of the umbilicus and xiphoid relative to the array were documented as anatomical references. After 30 minutes of fasting recording, each subject consumed a standardized meal and the study was continued for 90 minutes. The signal-to-noise ratio (SNR) for each electrode pair was calculated, defined as the average power between 0.04 Hz and 0.06 Hz divided by the average power in all other frequencies between 0.02 Hz and 0.20 Hz. We calculated the percentage of normal gastric slow waves, i.e., 2-4 cpm activity. The results from the highest SNR electrode pair were compared to those from the traditional single-channel EGG placement: one electrode halfway between the xiphoid and umbilicus and the second electrode placed 4-6 cm to the subjects left. Results: Using the highest SNR electrode pair, the percentage of normal slow waves was 92 ± 8%, and all 11 subjects were over the 70% threshold that defines normal. When using the traditional EGG electrode placement, however, this value dropped significantly to 68 ± 16%, and 6/11 subjects fell below 70% (see Table 1; Figure 1). Statistical significance of p = 4.4 x 10—5 was determined by a two-sided t-test for the null hypothesis that the two related samples have identical average values. This effect was particularly pronounced for the high BMI subjects. Conclusion: Standardization of cutaneous lead placement for EGG may be confounded by anatomical variability in stomach location coupled with an increased sensitivity to lead placement due to low signal amplitude. The results from this study suggest that multiple electrodes or a priori stomach localization can improve accurate detection of the gastric slow wave.
Introduction: The positioning of an intragastric balloon (saline or air filled) has been developed as temporary and reversible therapeutic option for treatment of obesity.The purpose of this study is ...to compare these two devices in terms of weight reduction parameters and patientstolerance. The research question of this study was as follows: Is there a difference in the BMI reduction and the rate of premature withdrawal between the two groups of patients? Methods: The participants of this study were patients who gone through gastric balloon procedure. The independent variables included were: the gender, the age, the type of gastric balloon (saline or air), and the initial body mass index (BMI). The established post procedure period was six months from the time of gastric balloon insertion. The outcome variables were the mean BMI loss after six monthsfrom the insertion and the rate of premature withdrawal due to intolerance.Quantitative method was applied using comparative design. A total of 113 patients: group A (87 patients) managed with saline-filled Bioenterics Intragastric Balloon -BIB, and group B (26 patients) managed with air-filled Endobag-Heliosphere Balloon?.Mean initial BMI was ( 37.96 ; SD6.17 Group A & 34.05 ;SD 5.89 for Group B) while the mean age ( 32.13;SD 8.71 GroupA & 37.42 ;SD10.29 for Group B) ;all of them were followed up in the same clinic with similar dietary instructions.Most of the participants (75.2%) were female.The air balloon was air-filled with 600 ml while the saline- filled balloon was filled with 500 ml of saline and 10 ml of methylene blue. Results: The BMI loss following the saline-filled balloon procedure ( M = 3.73, SD = 3.03) and the airfilled balloon procedure ( M = 1.75, SD = 1,81) with a significant difference (p< .001).Premature removal of the balloon was reported in 16 cases (14 for saline -filled balloon and 2 for air-filled ballon);and all the balloons were removed within one month from the insertion date due to vomiting, nausea and abdominal pain .There was no statistical significant difference in the mean score of withdrawal between the two groups. (p=.21 > .05). Conclusion: patients with saline-filled balloon procedure (M = 4.66, SD = 4.75) tend to lose weight (on average) significantly more than patient with air-filled balloon procedure (p < .001).On the other hand, the difference between the rates of premature withdrawal between the two groups was insignificant (P=0.21).
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