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This study evaluated the accuracy of the algorithmic oxygen saturation (SpO 2 ) nadir detection of WatchPAT (Zoll/Itamar, Caesarea, Israel) compared with visual inspection in a real-world setting. SpO 2 tracings for 209 consecutive adult WatchPAT recordings were reviewed for SpO 2 artifact, with erroneous SpO 2 data removed manually. Error rates for SpO 2 minima were determined across all studies, and relationships between correct and erroneous studies examined. The overall error rate for SpO 2 nadir was 22.5%. Erroneous studies had overall less time spent at SpO 2 ≤ 88%, higher true SpO 2 nadir, lower mean body mass index, and greater artifact time; however, these variables were not associated with the magnitude of discrepancy between manual and algorithmically derived SpO 2 minima. These data demonstrate that SpO 2 nadir determined by WatchPAT algorithms should not be considered universally accurate. Like other home sleep apnea tests, visual inspection and manual correction of the study data are often required to derive accurate clinical results. Citation: Plante DT, Rumble ME. Don’t hold PAT: watch for and correct oximetry artifact. J Clin Sleep Med . 2023;19(12):2113–2116.

Purpose Chronic graft-versus-host disease (cGVHD) is a common late complication of allogeneic hematopoietic cell transplantation (HCT). This study comprehensively evaluated physical and psychological function among individuals with cGVHD. Additional aims were to investigate relationships between disease severity and psychological and physical function, and to investigate patterns of psychological and physical function by disease site. Method Adults at least 6 months post allogeneic HCT were enrolled and either had cGVHD ( n  =59) or served as a reference sample of HCT survivors with no cGVHD history ( n  = 19). Participants completed self-report measures of depression, anxiety, fatigue, insomnia, pain, cognition, and sexual function and had a comprehensive clinical evaluation of cGVHD using NIH consensus scoring criteria. Participants with cGVHD were stratified by disease severity and site and compared to the reference group with no cGVHD. Results Participants with mild cGVHD had comparable psychological and physical symptoms to the reference sample, while participants with moderate cGVHD experienced more severe anxiety and problems with sexual function, and participants with severe cGVHD experienced more severe depressive symptoms and pain compared to the reference sample. Participants with cGVHD manifesting in the skin and GI tract had the most severe symptoms, including mood disturbance, fatigue, and pain. Conclusions and Implications for Cancer Survivors Results suggest that patients with more severe cGVHD and those with cGVHD manifesting in the skin, GI tract, and lungs are at risk for poorer psychological and physical outcomes and may benefit from proactive interventions to optimize function.

Study Objectives: Sleep disturbance is significantly associated with suicidal ideation. However, the majority of past research has examined the relationship between insomnia and suicidality. The current exploratory study examined the relationship of circadian rhythm dysregulation (eveningness, seasonality, and rhythmicity) with suicidality. Methods: We examined the association of insomnia, eveningness, seasonality, and rhythmicity with suicidal ideation in 103 participants with depression, insomnia, and suicidality within a larger 8-week double-blinded randomized control trial primarily examining whether cautious use of zolpidem extended-release or placebo reduced suicidal ideation. All participants additionally received an open-label selective serotonin reuptake inhibitor. Methodological strengths of the current analyses included consideration of multiple sleep-wake constructs, adjustment for relevant covariates, investigation of relationships over the course of treatment, and use of both self-report measures and objective measurement with actigraphy. Results: Over the course of treatment, self-reported eveningness and greater insomnia severity were independently correlated with greater suicidal ideation, whereas actigraphic delayed sleep timing was related to suicidal ideation at a trend level. At the end of treatment, those with greater suicidal ideation demonstrated lower actigraphic activity levels. There were no significant relationships between self-reported seasonality and actigraphic measures of sleep disturbance and suicidality. Conclusions: Self-reported delays in sleep timing, objectively lower activity levels, and self-reported insomnia severity correlated independently with greater suicidal ideation in those with depression, insomnia, and suicidality. These exploratory findings highlight the need to consider sleep-wake constructs more broadly in those with suicidality in future research studies in order to improve more definitively both assessment and intervention efforts. Clinical Trial Registration: Registry: ClinicalTrials.gov ; Name:Reducing Suicidal Ideation through Insomnia Treatment; URL: https://clinicaltrials.gov/ct2/show/NCT01689909 ; Identifier:NCT01689909

Introduction Obstructive sleep apnea (OSA), common in geriatric patients, has been associated with neurocognitive memory disorders such as Alzheimer's disease and other related dementias. An unusual pattern of memory testing has been found to be associated with OSA in a retrospective study (Dexter and Ebert, 2019). This atypical pattern is reported when immediate memory performance is lower than delayed memory performance on the repeatable battery for the assessment of neurological status (RBANS). The current study examines this cognitive testing results pattern coupled with snoring for predicting OSA in geriatric memory patients presenting to a university‐based memory clinic. Methods A convenience sample of patients presenting to the University of Wisconsin Hospitals and Clinics geriatric memory clinic from 2016‐2020 for cognitive assessments comprised the study population. Patients completed the mini‐mental state examination (MMSE) and obtained a score of 25 out of 30 points or greater and the patients were given the RBANS. Patients were referred for a sleep evaluation if they snored and their immediate memory index score was one or more points lower than their delayed memory index score on the RBANS. No other test score requirements were utilized to trigger the referral. Results Of the 251 patients (138 men; 113 women) referred based only on these two criteria to the associated sleep clinic, 158 (80%) were found to have OSA. Conclusion The prevalence of positive sleep studies suggests that memory clinic patients who snore and present this unusual pattern of results on the RBANS should be referred for a sleep evaluation for possible OSA.

Physical activity plays a key role in cancer survivorship. The purpose of this investigation was to (a) describe the post-surgical physical activity trajectories of endometrial (n = 65) and ovarian (n = 31) cancer patients and (b) identify clinical and demographic predictors of physical activity over time. 96 participants wore an Actiwatch accelerometer for three days at each of three time points (one week, one month and four months) after surgical intervention for their endometrial or ovarian cancer diagnosis. Analyses were conducted using linear mixed effects regression modeling in SAS 9.4. For both tumor types, although physical activity levels increased with time after surgery, even at four months patients were performing only a small fraction of the 150 minutes of recommended weekly moderate to vigorous physical activity. At 1 week, subjects were completing on average 14 minutes/week (SD = 4) of moderate-to-vigorous physical activity, compared to 14 minutes/week (SD = 2) of moderate-to-vigorous physical activity at four months post-surgery (p < .05). Better self-rated health was associated with higher physical activity (p = 0.02) in endometrial cancer survivors only. BMI, age, surgery type and use of neoadjuvant chemotherapy were not associated with activity over time. Our findings suggest that physical activity levels are different for those with better self-rated health, but those individuals are still insufficiently active. This study adds new information describing the trajectories and variables that influence physical activity in gynecologic cancer survivors after surgery and highlights the need for health promotion interventions in this population.

Despite a high prevalence of sleep disruption among hematopoietic cell transplant (HCT) recipients, relatively little research has investigated its relationships with modifiable cognitive or behavioral factors or used actigraphy to characterize sleep disruption in this population. Autologous HCT recipients who were 6–18 months post transplant completed self-report measures of cancer-related distress, fear of cancer recurrence, dysfunctional sleep cognitions, and inhibitory sleep behaviors upon enrollment. Patients then wore an actigraph for 7 days and completed a self-report measure of sleep disruption on day 7 of the study. Among the 84 participants (age M  = 60, 45% female), 41% reported clinically relevant sleep disruption. Examination of actigraph data confirmed that, on average, sleep was disrupted (wake after sleep onset M  = 66 min) and sleep efficiency was less than recommended (sleep efficiency M  = 78%). Cancer-related distress, fear of recurrence, dysfunctional sleep cognitions, and inhibitory sleep behaviors were related to self-reported sleep disruption ( p values<0.05) but not objective sleep indices. Results suggest that many HCT recipients experience sleep disruption after transplant. Cancer-related distress, fear of recurrence, dysfunctional sleep cognitions, and maladaptive sleep behaviors are related to self-reported sleep disruption and should be considered targets for cognitive behavioral intervention in this population.

Study Objectives: Depression has been identified as the most common condition comorbid to insomnia, with findings pointing to the possibility that these disorders may be causally related to each other or may share common mechanisms. Some have suggested that comorbid insomnia and depression may have a different clinical course than either condition alone, and may thus require specific treatment procedures. In this report we examined the clinical characteristics of individuals referred to an academic sleep center who report comorbid symptoms of insomnia and depression and those with symptoms of insomnia outside the context of meaningful depression, and we identified differences between these groups with regard to several cognitive-related variables. Methods: Logistic regression analyses examined whether past week worry, dysfunctional beliefs about sleep, and insomnia symptom-focused rumination predicted group membership. Results: Individuals with comorbid symptoms of insomnia and depression reported more past-week worry, dysfunctional beliefs about sleep, and insomnia symptom-focused rumination, than those with symptoms of insomnia without significant depression symptoms. When including all three cognitive-related variables in our model, those with comorbid symptoms reported more severe insomnia symptom-focused rumination, even when controlling for insomnia and mental health severity, among other relevant covariates. Conclusion: The findings contribute to our understanding of the complex nature of comorbid symptoms of insomnia and depression and the specific symptom burden experienced by those with significant depression symptoms in the presence of insomnia. The findings also highlight the need for increased clinical attention to the sleep-focused rumination reported by these patients. Citation: Levenson JC, Benca RM, Rumble ME. Sleep related cognitions in individuals with symptoms of insomnia and depression. J Clin Sleep Med 2015;11(8):847–854.

Introduction Performance of split-night polysomnography, the application and titration of positive airway pressure (PAP) therapy after an initial diagnostic interval, is a common practice in clinical sleep medicine. There is no currently recommended apnea-hypopnea index (AHI) threshold at which PAP should be applied during polysomnography. Differences in American Academy of Sleep Medicine (AASM) and Centers for Medicare and Medicaid Services (CMS) hypopnea scoring criteria and limitations on real-time hypopnea classification complicates identification of an optimal split-night threshold. Of particular concern is that patients may be “split” under AASM hypopnea rules but have insufficiently severe sleep disordered breathing under CMS rules to be diagnosed or treated appropriately. This study aimed to clarify optimal AHI thresholds for split night polysomnography in the context of a laboratory-wide transition from CMS to AASM hypopnea scoring criteria. Methods Effective October 1, 2021, our laboratory transitioned solely to scoring AASM-defined hypopneas, with additional post hoc identification of CMS hypopneas for reporting purposes. With this change, the split-night threshold was changed from 15 to 30/hr. All diagnostic polysomnograms (without PAP therapy) performed on adult patients through October 31, 2022, were retrospectively analyzed to clarify the effect of changing hypopnea scoring criteria in this context. Results 634 diagnostic polysomnograms were analyzed. An AHI threshold of 15/hr (using AASM hypopnea criteria) in the first two hours of sleep with at least 3 hours of time remaining for PAP titration would have resulted in 96 additional patients receiving treatment with PAP therapy. Among these, only one (1.04%) had CMS AHI below 5/hr. Sixty-eight of these patients had CMS AHI 5-15/hr during the first two hours of sleep. Among these, only eight patients did not have an additional comorbidity or symptom profile under CMS guidelines making them eligible for PAP therapy, however, none had CMS AHI >15/hr when the full night of sleep was analyzed. Conclusion Our study suggests there is little need to raise the split-night threshold when transitioning from CMS to AASM hypopnea criteria, and doing so substantially reduces the number of patients treated with PAP therapy in the sleep laboratory. Support (if any) None