Effectiveness of eHealth therapeutic education interventions in the management of fibromyalgia: protocol for a systematic review and meta-analysis.

INTRODUCTION: Non-pharmacological approaches have shown promising results in improving symptoms and quality of life of patients with fibromyalgia. However, these approaches may not be easily accessible or feasible for everyone. eHealth interventions may offer a more convenient and cost-effective approach to reach a wider range of patients with fibromyalgia and improve their outcomes. As eHealth tools become more prevalent in clinical practice, it is crucial to understand their effectiveness, limitations and how they can be integrated into standard care to optimise clinical outcomes. This systematic review aims to evaluate the effectiveness of eHealth therapeutic education interventions in managing fibromyalgia. METHODS AND ANALYSIS: Randomised controlled trials including eHealth therapeutic education interventions for individuals ≥18 years old with fibromyalgia, published in English or Spanish, will be retrieved by searching the databases PubMed, CINAHL Plus, EMBASE, Scopus, ISI Web of Science, PsycINFO and the Cochrane Central Register of Controlled Trials. Covidence software will be used for the selection of studies and data extraction. The risk of bias and the certainty of evidence will be assessed using the Cochrane Risk of Bias Assessment tool. We plan to perform a meta-analysis contingent on the number of studies retrieved and the interstudy heterogeneity, which will be explored with I2 statistics. ETHICS AND DISSEMINATION: This protocol and the subsequent systematic review will not collect individual-level data and do not require approval by an ethical committee. We intend to disseminate the study results via peer-reviewed scientific journals and relevant (inter)national conferences. PROSPERO REGISTRATION NUMBER: CRD42022343373.

Analysis of the determinants of sleep quality in a Spanish population: a study protocol for a cross-sectional study.

INTRODUCTION: Sleep problems are a growing public health concern being related, among others, to an increased risk of cardiovascular diseases or worse cognitive functioning. In addition, they can affect aspects related to personal motivation and quality of life. However, very few studies have analysed the possible determinants of sleep quality in the adult population as a whole, establishing patterns based on these determinants.The objectives are to evaluate the determinants of sleep quality in a representative sample of the general adult population between 25 and 65 years old, and to establish patterns of sleep quality based on lifestyles, psychological factors, morbidities, sociodemographic variables, biological markers and other possible determinants. METHODS AND ANALYSIS: Descriptive observational cross-sectional study. The study population will include a representative sample of 500 people between 25 and 65 years old from the cities of Salamanca and Ávila (Spain) selected by random sampling stratified by age groups and sex. A 90-minute visit will be performed, during which sleep quality will be assessed. The variables collected will be: morbidity, lifestyles (physical activity, diet, toxic habits), psychological factors (depression, stress, occupational stress and anxiety), socioeconomic and work-related variables, habitability conditions of the habitual residence and rest area, screen time, relaxation techniques and melatonin as a biological marker related to sleep quality. DISCUSSION: With the results of this work, improved interventions for behaviour modification could be designed, as well as intervention and education programmes or other research aimed at improving sleep quality. ETHICS AND DISSEMINATION: This study has a favourable opinion from the Ethics Committee for Drug Research of the Health Areas of Salamanca and Ávila (CEim Code: PI 2021 07 815). The results of this study will be published in international impact journals of different specialties. TRIAL REGISTRATION NUMBER: NCT05324267.

Association between burnout and adherence with mask usage and additional COVID-19 prevention behaviours: findings from a large-scale, demographically representative survey of US adults.

OBJECTIVES: Studies have found associations between occupational burnout symptoms and reduced engagement with healthy behaviours. We sought to characterise demographic, employment and sleep characteristics associated with occupational burnout symptoms, and to evaluate their relationships with adherence to COVID-19 prevention behaviours (mask usage, hand hygiene, avoiding gatherings, physical distancing, obtaining COVID-19 tests if potentially infected). METHODS: During December 2020, surveys were administered cross-sectionally to 5208 US adults (response rate=65.8%). Quota sampling and survey weighting were employed to improve sample representativeness of sex, age and race and ethnicity. Among 3026 employed respondents, logistic regression models examined associations between burnout symptoms and demographic, employment and sleep characteristics. Similar models were conducted to estimate associations between burnout and non-adherence with COVID-19 prevention behaviours. RESULTS: Women, younger adults, unpaid caregivers, those working more on-site versus remotely and those with insufficient or impaired sleep had higher odds of occupational burnout symptoms. Burnout symptoms were associated with less frequent mask usage (adjusted odds ratio (aOR)=1.7, 95% CI 1.3-2.1), hand hygiene (aOR=2.1, 95% CI 1.7-2.7), physical distancing (aOR=1.3, 95% CI 1.1-1.6), avoiding gatherings (aOR=1.4, 95% CI 1.1-1.7) and obtaining COVID-19 tests (aOR=1.4, 95% CI 1.1-1.8). CONCLUSIONS: Disparities in occupational burnout symptoms exist by gender, age, caregiving, employment and sleep health. Employees experiencing occupational burnout symptoms might exhibit reduced adherence with COVID-19 prevention behaviours. Employers can support employee health by addressing the psychological syndrome of occupational burnout.

Psychological treatments for the mental health symptoms among individuals infected with COVID-19: a scoping review protocol.

INTRODUCTION: Mental health symptoms such as depression, anxiety and sleep problems are commonly observed in individuals suffering from acute COVID-19 infection to post-COVID-19 syndrome. Studies have provided preliminary evidence for the efficacies of cognitive behavioural therapy, mindfulness-based interventions, acceptance and commitment therapy, and many other treatments for this population. Although there have been attempts to synthesise the literature on these psychological interventions, previous reviews have been limited in terms of the sources, symptoms and interventions that they included. Furthermore, most studies reviewed were conducted in early 2020, when COVID-19 had only recently been classified as a global pandemic. Since then, substantial research has been conducted. As such, we sought to provide an updated synthesis of the available evidence of treatments for the range of mental health symptoms associated with COVID-19. METHODS AND ANALYSIS: This scoping review protocol was developed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Systematic searches were carried out on scientific databases (PubMed, Web of Science, PsycINFO and Scopus) and clinical trial registries (ClinicalTrials.gov, WHO ICTRP, EU Clinical Trials Register and Cochrane Central Register of Controlled Trials) to identify studies that have or will assess the efficacy or any aspects of psychological treatment for acute to post-COVID-19 syndrome. The search was conducted on 14 October 2022 and identified 17 855 potentially eligible sources/studies published since 1 January 2020 (duplicates removed). Six investigators will independently carry out titles and abstract screening, full-text screening and data charting and the results will be summarised using descriptive statistics and narrative synthesis. ETHICS AND DISSEMINATION: Ethical approval is not required for this review. The results will be disseminated through a peer-reviewed journal, conference presentations and/or academic newspapers. This scoping review has been registered with Open Science Framework (https://osf.io/wvr5t).

Effects of the COVID-19 pandemic on sleep health among Middle Eastern and North African (MENA) populations: a systematic review of the literature.

OBJECTIVES: This study sought to conduct a systematic review of the literature on the impact of the COVID-19 pandemic on sleep health among Middle Eastern and North African (MENA) populations, understudied geographic regions including with regards to sleep health. SETTING: A systematic literature search of studies published from inception to 27 March 2022 was conducted on multiple databases using developed keywords. PARTICIPANTS: Studies were included if they (1) investigated one or more aspects/dimensions of sleep health as an outcome (eg, sleep duration, sleep quality, sleep problems); (2) measured the impact of a COVID-19 pandemic-related domain (eg, impact of quarantine, work from home, lifestyle changes); (3) focused on at least one MENA region population; (4) were peer-reviewed; (5) included ≥100 participants; (6) were written in English and (7) had full-text article publicly available. PRIMARY AND SECONDARY OUTCOMES MEASURED: Primary outcomes were sleep duration, sleep quality and sleep problems. RESULTS: In line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 164 studies were included for data extraction. The Newcastle-Ottawa scale for cross-sectional studies was used to assess the quality of the studies. Overall, the COVID-19 pandemic significantly impacted sleep duration, sleep quality and presence and severity of sleep disorders in MENA populations, including adults, children, students, healthcare workers and people with chronic illnesses. The directionality and strength of associations, as well as the determinants of sleep health, varied by subpopulations. CONCLUSIONS: Longitudinal studies are needed to understand the longer-term impact of the COVID-19 pandemic on the sleep health of MENA populations. Sleep health interventions and policy measures should be tailored to the need of each subpopulation. PROSPERO REGISTRATION NUMBER: CRD42022321128.

Impact of mail-based continuous positive airway pressure initiation on treatment usage and effectiveness.

PURPOSE: In-person visits with a trained therapist have been standard care for patients initiating continuous positive airway pressure (CPAP). These visits provide an opportunity for hands-on training and an in-person assessment of mask fit. However, to improve access, many health systems are shifting to remote CPAP initiation with equipment mailed to patients. While there are potential benefits of a mailed approach, relative patient outcomes are unclear. Specifically, many have concerns that a lack of in-person training may contribute to reduced CPAP adherence. To inform this knowledge gap, we aimed to compare treatment usage after in-person or mailed CPAP initiation. METHODS: Our medical center shifted from in-person to mailed CPAP dispensation in March 2020 during the COVID-19 pandemic. We assembled a cohort of patients with newly diagnosed obstructive sleep apnea (OSA) who initiated CPAP in the months before (n = 433) and after (n = 186) this shift. We compared 90-day adherence between groups. RESULTS: Mean nightly PAP usage was modest in both groups (in-person 145.2, mailed 140.6 min/night). We did not detect between-group differences in either unadjusted or adjusted analyses (adjusted difference - 0.2 min/night, 95% - 27.0 to + 26.5). CONCLUSIONS: Mail-based systems of CPAP initiation may be able to improve access without reducing CPAP usage. Future work should consider the impact of mailed CPAP on patient-reported outcomes and the impact of different remote setup strategies.

Evaluation of sleep medicine fellowship program websites.

STUDY OBJECTIVES: Sleep fellowship program websites likely serve as a preliminary source of information for prospective fellows. Arguably, applicants have likely become even more reliant on program websites during the COVID-19 pandemic due to travel restrictions and social-distancing measures limiting in-person interviews. In this study, we evaluated the content and comprehensiveness of sleep medicine fellowship websites to identify areas of improvement. METHODS: A list of sleep medicine fellowship programs in the United States participating in the 2021 match cycle was compiled using the Electronic Residency Application Service (ERAS) and Fellowship and Residency Electronic Interactive database (FREIDA) websites. Twenty-two prespecified content criteria related to education, recruitment, and compensation were used to evaluate each program website. Sleep programs' website comprehensiveness were compared based on US location, type, matching status, core specialty, and size of programs. RESULTS: Seventy-eight US sleep fellowship program websites were evaluated. Most program websites had a working hyperlink on ERAS or FREIDA. There was considerable variability in content reported across program websites, with a mean of 56.8% of content items reported per program. There was a greater educational website content comprehensiveness for internal medicine compared with other specialty-based sleep programs. There was no difference in sleep programs' website comprehensiveness based on US location, type, matching status, or size of programs. CONCLUSIONS: Website content comprehensiveness among sleep fellowship programs is variable. There is opportunity for all sleep fellowship programs to improve their websites to better inform prospective trainees. CITATION: Shenoy S, Akberzie W, Landeo-Gutierrez JS, Leon Guerrero CR, Karroum EG. Evaluation of sleep medicine fellowship program websites. J Clin Sleep Med. 2023;19(6):1083-1088.

A new multi-level encryption and decryption software for clinical data exchanges in sleep medicine (ASCLEPIOS) M. Salanitro1

Introduction: Clinical data exchange between physicians and other medical experts has become more common in recent years, especially since the shift to home office has increased due to the Covid-19 pandemic. This can be problematic for sleep specialists since sleep recordings cannot be easily transferred in a safe and secure manner - A typical recording contains a large volume of sensitive data with multiple parameters (e.g., brain activity, heart rate, pulse oximetry, respiratory flow, cardiac current flow).Therefore, in sleep medicine, a platform that allows safe uploading, downloading, and sharing of patient data is necessary for quality control. Method(s): A new multi-level encryption and decryption software called XNAT was developed by the ASCLEPIOS project to ensure the safety of clinical data exchanges. The clinical and technical partners together trialed this platform and assessed the functionality for sensitive data transfer. The sensitive data used in this assessment were 19 original home sleep recordings (6-channel polysomnographic data). Result(s): The clinical and technical partners successfully uploaded 19 raw European Data Format (+) files (sleep recordings) to the XNAT platform, which were immediately pseudonymized. The XNAT platform provided all necessary and important functions in the context of data security: Firstly, all uploaded data followed data privacy regulations and were encrypted with symmetric searchable encryption, attribute-based access control services, attribute-based encryption, and functional encryption. Secondly, all uploaded data could be successfully decrypted, downloaded, annotated, and re-uploaded by both clinical and technical partners. This meant that events in the recordings could be marked and labeled with the suspected relevant medical terms. These annotations were subsequently visible to all other collaborating partners and could be amended if the annotations were incorrect. As a result, sleep scoring with quality control was conducted remotely by both partners. Conclusion(s): Overall, the multi-level encryption platform developed by the ASCLEPIOS project allowed both clinical and technical partners to keep sensitive patient data secure whilst being able to collaborate with one another on the same patient data. This opens new opportunities for sleep specialists to gain a second opinion and quality control.

SLEEP-DISORDERED BREATHING AND LONG-HAUL COVID-19: A CASE REPORT

SESSION TITLE: Uncommon Presentations and Complications of Chest Infections SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 10:15 am - 11:10 am INTRODUCTION: The correlation between long-haul Coronavirus 2019 (COVID-19) and sleep disorders remains poorly understood. In this report, we present a case of newly diagnosed central sleep apnea (CSA) and symptoms starting after a COVID-19 infection as part of a long-haul COVID-19 presentation. CASE PRESENTATION: A 69-year-old male presented to a sleep medicine clinic for evaluation of hypersomnia. He had a history of hypertension and pulmonary embolism. He contracted COVID-19 eight months prior to his presentation. He was not hospitalized, but received Remdesivir and prednisone. He complained of long-haul COVID-19 symptoms since his infection which included headaches, fatigue, cough, dyspnea, anosmia, poor appetite, dysgeusia, and memory impairment. He also started noticing nocturnal apneic episodes that frightened him and woke him up from sleep. His symptoms started after his infection and were not present prior. He went to the emergency department for evaluation and no etiology was identified. He was then referred to sleep medicine for further evaluation. A home sleep apnea test was done and showed severe sleep apnea with an Apnea-Hypopnea Index of 35.7 events per hour. His sleep apnea was predominantly central with a central apnea index of 15.3 events per hour. Cardiac testing showed no evidence of ischemia or cardiomyopathy with an ejection fraction of 52%. A CT angiogram showed no evidence of PE. Brain MRI showed no acute abnormalities. He was started on positive airway pressure therapy but could not tolerate it so he was sent for a phrenic nerve stimulator implantation. DISCUSSION: Long-term sequelae of COVID-19 infection have been increasingly recognized. However, the etiology and pathophysiology is poorly understood (1). Symptoms of long-haul COVID-19 include fatigue, dyspnea, cognitive manifestations, thrombosis and sleep disturbances (1). Sleep apnea was found in some studies to be a risk factor for severe COVID-19 illness and worse outcomes (2). The relationship between COVID-19 and sleep apnea in the post-viral syndrome remains unknown. Only few case reports have found obstructive sleep apnea as a new diagnosis and a possible cause of fatigue in post COVID-19 infection (3). There is no report of a relationship between CSA and COVID-19 in the literature. It is hypothesized that long-COVID can lead to brainstem dysfunction and dysautonomia, which can affect the ventilatory control mechanisms and lead to an unstable respiration (4–6). Our patient's nocturnal symptoms started after his infection as part of long-haul COVID-19. While we cannot determine if CSA was a result of COVID-19 infection or not, it is important to evaluate for sleep disordered breathing (SDB) in patients presenting with long-COVID symptoms to better understand the association. CONCLUSIONS: More research is need to better understand the correlation between SDB and long-haul COVID-19. Reference #1: 1. Mehandru S, Merad M. Pathological sequelae of long-haul COVID. Nat Immunol. 2022 Feb;23(2):194–202. 2. Miller MA, Cappuccio FP. A systematic review of COVID-19 and obstructive sleep apnoea. Sleep Medicine Reviews. 2021 Feb;55:101382. Reference #2: 3. Koczulla AR, Stegemann A, Gloeckl R, Winterkamp S, Sczepanski B, Boeselt T, et al. Newly detected rapid eye movement associated sleep apnea after coronavirus disease 2019 as a possible cause for chronic fatigue: two case reports. J Med Case Reports. 2021 Dec;15(1):211. 4. Barizien N, Le Guen M, Russel S, Touche P, Huang F, Vallée A. Clinical characterization of dysautonomia in long COVID-19 patients. Sci Rep. 2021 Dec;11(1):14042. Reference #3: 5. Yong SJ. Persistent Brainstem Dysfunction in Long-COVID: A Hypothesis. ACS Chem Neurosci. 2021 Feb 17;12(4):573–80. 6. White DP. Pathogenesis of Obstructive and Central Sleep Apnea. Am J Respir Crit Care Med. 2005 Dec;172(11):1363–70. DISCLOSURES: No relevant relationships by Amer Als ekh Mousa No relevant relationships by University of Arizona at Banne Institute No relevant relationships by Joyce Lee-Iannotti No relevant relationships by Anas Rihawi No relevant relationships by Amr Salem No relevant relationships by Mohanad Soliman No relevant relationships by Kristen Trimble

Obstructive sleep apnoea and perioperative medicine: a growing concern.

Obstructive sleep apnoea represents a sizable public health and economic burden. Owing to rising obesity rates, the prevalence of obstructive sleep apnoea is increasing, and it is a condition that is significantly underdiagnosed. Exacerbated by the COVID-19 pandemic, the backlog of elective surgeries is also sizable and growing. A combination of these factors means that many patients due to have surgery will have obstructive sleep apnoea, either diagnosed or otherwise. Patients with obstructive sleep apnoea have a significantly increased risk of operative complications, but the evidence base for optimum perioperative management of these patients is limited. This article reviews sleep apnoea, its prevalence and its impact on operative management and perioperative outcomes for patients. The evidence base for screening and treating undiagnosed obstructive sleep apnoea is also comprehensively assessed. Finally, a pathway to manage patients with possible undiagnosed obstructive sleep apnoea is proposed, and areas for further research identified.

Risk factors for the prevalence of poor sleep quality in lecturers during COVID-19 pandemic in Ethiopia: an institution-based cross-sectional study.

OBJECTIVE: This study was conducted to assess the prevalence and risk factors of poor sleep quality (SQ) among the academic staff at the University of Gondar, Northwestern Ethiopia. DESIGN: An institution-based cross-sectional study was conducted from March to April 2021. A validated, self-administered, standardised Pittsburgh Sleep Quality Index (PSQI) was used to quantify the amount of self-reported poor SQ. The collected data were entered into EpiData V.4.6 and analysed using Stata V.14 software. Binary logistic regressions were computed to determine the association between variables. The association was determined using an adjusted OR (AOR) with a 95% CI at a p value of <0.05. SETTING: The study was conducted at the University of Gondar, Northwestern Ethiopia. PARTICIPANTS: A total of 607 lecturers participated in this study. OUTCOME MEASURES: The primary outcome is the prevalence of poor SQ, which was measured using the PSQI. RESULTS: Overall response rate was 95.60% (N=607). The age of the participants ranges from 21 to 70 with a mean of 32.39 (SD±6.80) years. The magnitude of poor SQ during the COVID-19 pandemic in the last month was 60.30% (95% CI (56.28% to 64.21%)). Working greater than 10 hours per day (AOR=2.19, 95% CI (1.16 to 4.27)), electronic device use before bedtime (AOR=1.53, 95% CI (1.04 to 2.27)), high-risk perception of COVID-19 infections (AOR=1.60, 95% CI (1.04 to 2.46)) and perceived job stress (AOR=2.15 (95% CI (1.50 to 3.08)) were risk factors for poor SQ. CONCLUSION: The study revealed that the prevalence of poor SQ was high during the COVID-19 pandemic. The finding highlights the importance of optimising the working hours per day, minimising electronic device use before bedtime, promoting risk perception toward COVID-19 infection and developing workplace coping strategies for stress, which play a substantial role in minimising poor SQ.

TOGETHER FOR THE LONG HAUL: DEVELOPMENT AND UTILIZATION OF A POST-ACUTE COVID- 19 RECOVERY PROGRAM EMBEDDED WITHIN A LARGE, URBAN ACADEMIC GENERAL INTERNAL MEDICINE DIVISION

STATEMENT OF PROBLEM/QUESTION: Post-acute COVID-19 syndrome presents new diagnostic and management challenges for primary care physicians, creating a need for dedicated care for affected patients. DESCRIPTION OF PROGRAM/INTERVENTION: To date, the COVID19 pandemic has infected >300 million people worldwide. It is estimated that more than 50% develop Post-acute COVID-19 syndrome. Symptoms persisting >6 months lead to activity impairment and reduced quality of life. In March 2021, we implemented a Post-acute COVID-19 recovery program embedded in a primary care setting. Using an integrated approach, the program utilizes a patient navigator who performs a standardized intake process and assists with information collection and navigation to specialty care. Social workers assist with mental health/community resource access. Five general internal medicine physicians see referred patients 5 half days a week in multiple locations. Intake visits review patient history, previous testing, and ongoing symptoms, and a standard quality of life evaluation is made with a PROMIS-29 score. Templates use new patient and return visits times of 40 minutes (6 slots) and 20 minutes (2 slots) respectively. Expedited specialty care is achieved through prioritized access within two weeks through collaboration with numerous specialists. Monthly case conferences allow clinicians to connect with specialists, discussing challenging cases and common clinical scenarios (e.g., dysosmia, dysgeusia). Additionally, a support group for patients is being developed, as is an “e-consult” option for primary care physicians to engage with the clinic. MEASURES OF SUCCESS: Referrals to program, patients seen, template fill rate, no show rate, new patient visit lag time, revenue generated, and medical diagnoses treated. Future measures will include interval comparison of PROMIS- 29 scores and utilization of e-consults. FINDINGS TO DATE: There have been 557 formal referrals to the program with 620 total patients seen. 584 (84%) were seen by general internal medicine as first contact. Template utilization: 93% and No-show rate of 7%. Median new patient lag: 28 days. Through December 2021, total charges and payments have been $173,445 and $79,692, respectively. Top 3 procedure codes billed: 99215, 99244, and 99214. Top 5 categories of symptoms by primary diagnostic code billed excluding post viral syndrome (111 patients, 18%): Neurologic (headache, fatigue, inattention, etc) (149 patients, 24%), Respiratory (128, 20%), Cardiac (64, 10%), Psychiatric (59, 9.5%), Loss of taste/smell (24, 4%). Top 5 referrals from program: PT/OT/speech therapy, pulmonary rehab, ENT, sleep medicine, and psychology/psychiatry. KEY LESSONS FOR DISSEMINATION: There is high demand for expertise in treatment of Post-Acute COVID-19 syndrome. Primary care physicians, coupled with dedicated, timely access to specialty care and rehab services can successfully manage patients with post-COVID-19 symptoms.

Sleep telemedicine in Germany: a developed model

Telemedicine has advanced and grown enormously during the last 10 years. Due to the Sars-CoV2 pandemia the pace of digitalizing diagnostics and therapy in the field of sleep medicine has accelerated. In Germany the main fields of sleep telemedicine are the group of sleep disordered breathing and the group of insomnias. Although there are several initiatives which aim an inventing digital sleep technologies as telemedical recording of relevant data for the diagnostics of obstructive apnea syndrome or digital applications for the treatment of insomnia coordinated approaches are being developed. The German Sleep Society aims on coordinating all initiatives with several approaches. Here the main focus is the standard which a needed for quality aspects. Another aspect is to transform the German health system, which is divided into the public and the private health insurance system, into a more flexible and digital friendly one accepting that sleep medicine is one of the best example to implement digital techniques for telemedicine. The German state of the art in the field of sleep telemedicine will be reflected to open the chance for other countries to have a deeper insight in the challenges and shortcomings for implementing sleep telemedicine in a highly sophisticated health care system.

LONGITUDINAL ASSESSMENT OF CPAP USE IN SLEEP MEDICINE CLINIC PATIENTS DURING THE COVID-19 PANDEMIC

Introduction: Due to the COVID-19 pandemic, there may be changes in continuous positive airway pressure (CPAP) adherence. This study aimed to examine the longitudinal effect of using CPAP as advised and self-reported sleep quality improvements in sleep medicine clinic patients using CPAP early in the pandemic and six months later. Methods: Between June-November 2020, 81 sleep medicine clinic patients completed an online survey that included questions about CPAP use, using CPAP as advised, and changes in sleep quality associated with CPAP use. Patients were recontacted 6 months later to complete the same survey. Among survey respondents completing both surveys, 27 (50%;aged 58±18.2 y, 48% female, 67% Caucasian) reported using CPAP and were included in the present analysis. We conducted multivariate regression analyses Chisquare Association tests to determine whether self-reported CPAP use, CPAP use as advised, and sleep quality changed from baseline to 6-month follow up during the pandemic. Results: Among CPAP users, 89% reported no change, 7% reported they use CPAP more, and 4% reported they use CPAP less at 6-month follow up. There was a significant increase in using CPAP as advised at 6-month follow up compared to the baseline survey, p=0.003. Additionally, there was a significant improvement self-reported sleep quality while using CPAP at 6-month follow up compared to the baseline survey, p=0.012. Conclusion: Patients reported an increase in using CPAP advised and improvements in sleep quality as a result of CPAP use at 6-month follow up compared to a baseline survey administered early in the pandemic. Understanding why patients are more adherent to using CPAP as advised during the pandemic may help in developing interventions to increase CPAP adherence.

DEPRESSION, ANXIETY AND COPING-AVOIDANCE BEHAVIORS ASSOCIATED WITH LONG-TERM INSOMNIA SYMPTOMS DURING THE COVID-19 PANDEMIC

Introduction: Stressful events, such as the COVID-19 pandemic, can have long-lasting, detrimental effect on sleep. It is important for practitioners to understand how their patients may be stil experiencing residual negative effects of the pandemic to optimize their care. In this study we evaluated how measures of self-reported measures of anxiety and depression during the COVID-19 pandemic predicted measures of sleep disturbnce 6 months later among sleep medicine clinic patients. Methods: Between June-November 2020, 81 sleep medicine clinic patients (54.8±15.9 y, 44% male, 69% Caucasian) completed an online survey that included PROMIS measures (Sleep Disturbance, Sleep-Related Impairments, Informational Support, Emotional Distress-Anxiety) and Insomnia Severity Index (ISI). Patients were recontacted 6 months later to complete the same surveys. 54 patients (55.2±18.4 y, 39% male, 70% Caucasian) completed the follow-up survey and were included in this present analysis. We conducted multivariate regression analyses to determine how the change in self-reported PROMIS measures from baseline during the pandemic were predictive of post-pandemc 6 month follow-up PROMIS measures and ISI. Results: PROMIS depression score at baseline was predictive of both sleep disturbance (0.63 ± 0.15;p<.0001) and sleep impairment (0.49 ± 0.18;p=0.01) 6 months later. Baseline brief coping avoidance also predicted 6 month sleep disturbance (0.85 ± 0.33;p<0.009) and sleep impairment (0.85 ± 0.33;p=0.014) as well as ISI (0.52 ± 0.18 units;p=0.006). Baseline anxiety predicted ISI at 6 months (0.25 ± 0.09 units, p=0.009). Conclusion: Higher levels of self-reported depression, anxiety and coping-avoidance behaviors during the COVID-19 pandemic lead to long-lasting increase in sleep disturbance and impairment as well as insomnia. Addressing depression, anxiety and coping behaviors that occur as result as a stressful event is advised to avoid long-term detrimental effects on sleep.

CHANGES IN HEALTHCARE VISITS AND EXERCISE HABITS ASSOCIATED WITH POOR SLEEP IN SLEEP MEDICINE PATIENTS DURING THE COVID-19 PANDEMIC

Introduction: Patients may be experiencing increased stress and sleep disturbance due to healthcare and changes in daily habit during the COVID-19 pandemic. Healthcare changes may include telemedicine visits, delayed or canceled appointments and sleep studies. The purpose of this study was to assess the association between changes in healthcare and daily habits on sleep. Methods: Sleep medicine clinic patients completed an online survey during the pandemic and again 6 months later (December 2020 - May 2021), where they answered questions about COVID- 19 (COVID-19 vaccination and test results, changes in health care visits and habits during the pandemic), PROMIS measures (Sleep Disturbance, Sleep-Related Impairments), and Insomnia Severity Index (ISI). General linear regression model was performed using SAS to determine if changes in healthcare and daily habits predicted poorer sleep. Results: Among 81 patients who completed baseline survey, 54 (aged 55.2±18.4 y, 61% female, 70% Caucasian) completed the 6-month follow-up survey. Among them, 6% tested positive for COVID-19 and 83% were vaccinated. 30% changed their healthcare office appointments to telephone visits, 50% changed to video visits;whereas 22% cancelled and 30% rescheduled their healthcare appointments. At baseline, changes in health care visits had significant increase on ISI (3.98 ± 1.66, p=0.02). Upon follow-up, changes in health care visits had significant increase on ISI (4.77 ± 2.12, p=0.03) and Sleep Impairments (7.97 ± 3.83, p=0.04). A decrease in exercise predicted lower Sleep Disturbance (6.81 ± 3.31, p=0.04). Conclusion: Sleep medicine patients who reported changes in health care visits at baseline and 6-month follow up reported higher insomnia severity, and sleep-related impairments. Changes in healthcare had deleterious effects on sleep and should be considered when managing patients' healthcare. Unexpectedly, patients who reported a reduced level of exercise reported improved sleep. Pandemic public policies (e.g., gym closures) may have made it more difficult to exercise but allowed for greater opportunity to sleep.

SLEEP MEDICINE CARE THROUGH THE COVID-19 PANDEMIC

Introduction: The COVID-19 pandemic accelerated use of telehealth, an expansion of services that required the appropriate technological infrastructure for health care facilities and in patient homes. Telehealth on the one hand has held promise for addressing health disparities perpetuated by inadequate rural access, but delivery requires extensive broadband and technologic access. That creates the possibility for new kinds of healthcare disparities. In addition, COVID-19 forced marked reduction in in-lab polysomnography (PSG), and concurrent expansion of home sleep apnea testing (HSAT). We hypothesized that the pandemic led to an increase in the overall frequency of telehealth and HSAT utilization, particularly in those who were younger, White, more educated, and from a non-local area. Methods: We completed a retrospective chart review of all adult patients seen by all provider types across the Sleep Medicine practices in Mayo Clinic Rochester, Arizona, Florida, and the Mayo Clinic Health System between 1) 6/1/183/8/20 (Pre-COVID-19), 2) 3/9/204/19/20 (Early COVID-19), and 3) 4/20/20present (Late COVID-19). We recorded the total number of PSGs and HSATs and total number of face-to-face and telehealth visits, along with the age, gender, race, educational level, and locality by zip code for patients served. These data were compared across the 3 timeframes. Results: Average monthly visits changed from Pre-COVID-19, Early COVID-19, to Late COVID-19 [2194.7/m, 1416.5/m, 2690.6/m (P<0.001)]. Average monthly sleep test volumes also changed [1004.1/m, 530.5/m, 1123.4/m (P<0.001)], with a proportionate increase in HSATs across the 3 periods [34.71%, 65.37%, 53.59% (P<0.005)]. The increase in Late COVID-19 in telehealth visits occurred proportionately more in those who were younger, female, non-White, college and post-graduate educated, and from a non-local area. The increase in use of HSATs occurred proportionately more in patients who were younger, female, non-White, college and post-graduate educated, and from a local area. Conclusion: The COVID-19 pandemic increased the use of telehealth visits and HSATs in Sleep Medicine practices across our enterprise, particularly in those who are younger and more educated, which may be due to ease of use with and access to technology. The reasons for the presence of additional disparities based upon gender, race, and locality needs further exploration.

What are the respiratory health research priorities in Alberta, Canada? A stakeholder consultation.

OBJECTIVE: The Respiratory Health Strategic Clinical Network (RHSCN) was launched to facilitate respiratory and sleep health through implementation of innovative, patient-centred, evidence-informed coordinated services in Alberta. In collaboration with project partners, the RHSCN aimed to determine the respiratory research priorities for Alberta. DESIGN: The four phases of this research prioritisation project were (1) identifying research questions from stakeholders, (2) determining which research questions had been answered in existing literature, (3) prioritising unanswered questions and (4) finalising the priorities through an inperson workshop. SETTING: The study occurred in Alberta, Canada over a 2-year period beginning in March 2017. PARTICIPANTS: A total of 448 patients, clinicians and other stakeholders consented to participate in the survey. RESULTS: A total of 595 possible questions were submitted, with 343 unique questions identified. Of the questions, 94 were out of scope, 155 answered by existing literature and 10 were combined with others, while 83 were determined to be unanswered in the literature. Stakeholders were surveyed again to prioritise the remaining 83 questions and they were reviewed by the project's Steering Committee (clinicians and patients). At the inperson workshop, the Steering Committee identified 17 research topics as priority areas for respiratory and sleep research in Alberta. CONCLUSION: A stakeholder-led research prioritisation process identified optimal clinical management/follow-up, equitable access to services, and management of social, psychological and mental health issues related to respiratory/sleep health as priority research areas.

Study protocol for the Shifting Weight using Intermittent Fasting in night shift workers (SWIFt) study: a three-arm randomised controlled trial comparing three weight loss strategies in night shift workers with obesity.

INTRODUCTION: Shift workers are at an increased risk of developing obesity and type 2 diabetes. Eating and sleeping out of synchronisation with endogenous circadian rhythms causes weight gain, hyperglycaemia and insulin resistance. Interventions that promote weight loss and reduce the metabolic consequences of eating at night are needed for night shift workers. The aim of this study is to examine the effects of three weight loss strategies on weight loss and insulin resistance (HOMA-IR) in night shift workers. METHODS AND ANALYSIS: A multisite 18-month, three-arm randomised controlled trial comparing three weight loss strategies; continuous energy restriction; and two intermittent fasting strategies whereby participants will fast for 2 days per week (5:2); either during the day (5:2D) or during the night shift (5:2N). Participants will be randomised to a weight loss strategy for 24 weeks (weight loss phase) and followed up 12 months later (maintenance phase). The primary outcomes are weight loss and a change in HOMA-IR. Secondary outcomes include changes in glucose, insulin, blood lipids, body composition, waist circumference, physical activity and quality of life. Assessments will be conducted at baseline, 24 weeks (primary endpoint) and 18 months (12-month follow-up). The intervention will be delivered by research dietitians via a combination of face-to-face and telehealth consultations. Mixed-effect models will be used to identify changes in dependent outcomes (weight and HOMA-IR) with predictor variables of outcomes of group, time and group-time interaction, following an intention-to-treat approach. ETHICS AND DISSEMINATION: The study protocol was approved by Monash Health Human Research Ethics Committee (RES 19-0000-462A) and registered with Monash University Human Research Ethics Committee. Ethical approval has also been obtained from the University of South Australia (HREC ID: 202379) and Ambulance Victoria Research Committee (R19-037). Results from this trial will be disseminated via conference presentations, peer-reviewed journals and student theses. TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry (ACTRN-12619001035112).