1082 Offsprings Autistic Behaviors Modify The Relationships Between Maternal Peritraumatic Distress And Sleep Disturbance Following Trauma Exposure

Introduction

Neurodevelopmental impairments may alter parents’ sleep and add tremendous stress to their families’ routine. This study examined the relationship between peritraumatic distress, and sleep disturbances among mothers who were exposed to the 2010 Haitian earthquake during pregnancy and whether this relationship is moderated by offspring‘s autistic behaviors.

Methods

Sample includes 361 mother-offspring dyads [mean (SD) age= 27.31 (5.93); 3.1/2(3.88)] who survived the 2010 earthquake in Haiti. Maternal data were collected 3 years following the event via the Earthquake Experience Questionnaire (EEQ), the Peritraumatic Distress Inventory (PDI), and the sleep items of the PTSD Checklist (PCL-S) (such as trouble falling or staying asleep, and repeated disturbed dreams in response to the disaster exposure). Child-related data were obtained from maternal completion of the Echelle d’Evaluation des Comportements Autistiques Revisee (ECAR) (Autistic Behaviors Scale Revised). Pearson Correlations, multilinear regression and interaction effect analyses were conducted to explore the association between peritraumatic distress, offspring’s autistic behaviors and sleep disturbance among the participants.

Results

10.7% of mothers were caught under rubble or were seriously injured during the event. Three years later, 56.83% and 52.9% of them had consequent disturbed sleep and nightmares, respectively. Maternal sleep disturbance correlated positively with peritraumatic distress (r=.38, p=.01) and offspring autistic behaviors (r=.13, p=.05). As hypothesized, adjusting for covariates, peritramatic distress was the strongest predictor of maternal sleep disturbance (B=.310, p<.001). The relationship between maternal peritraumatic distress and sleep disturbance was modified by offspring autistic behaviors (B=.138, p= .015).

Conclusion

This is the first study to document the prolonged effect of peritraumatic distress during the 2010 Haitian earthquake on mother’s sleep disturbance and whether this relationship is moderated by offspring autistic behaviors. The findings support the importance of a sleep component in maternal and child health in disaster preparedness program.

Support

This study was supported by funding from the NIH: T32HL129953

0235 Sleep Duration and Timing Associated with Eating Behaviors: Data from NHANES 2015–2016

Introduction

Previous studies have shown that, in the laboratory, sleep deprivation leads to unhealthy eating patterns. In real-world samples, lack of sleep is associated with obesity. Few real-world studies of sleep and food intake patterns exist, especially from nationally-representative samples.

Methods

Data from the 2015–2016 National Health and Nutrition Examination Survey (NHANES) were used. NHANES is a national-representative survey collected by the CDC. N=6,291 participants provided data about dietary behaviors and sleep timing. Dietary behaviors included the number of meals not made at home in the past 7 days (NOTHOME), number of fast food/pizza meals in the past 7 days (FASTFOOD), number of pre-made meals in the past 30 days (PREMADE), and number of frozen meals in the past 30 days (FROZEN). Linear regression models examined these as outcomes and predictors including bedtime (minutes), waketime (minutes), sleep duration (hours), and daytime tiredness/fatigue (never, rarely, sometimes, often). Covariates included age, sex, education, income/poverty ratio, race/ethnicity, and body mass index.

Results

Number of meals not made at home (NOTHOME) was associated with a later bedtime (B=2.25, p=0.01) and shorter sleep duration (B=-0.12, p=0.01). FASTFOOD was associated with shorter sleep (B=-0.13,p=0.003) and tiredness/sleepiness sometimes (B=0.77, p=0.007) and often (B=0.55, p=0.03). FROZEN meals were associated with a later waketime (B=3.31, p=0.003) and tiredness/sleepiness sometime (B=1.20, p=0.025) and often (B=1.60, p=0.04). A sleep duration by bedtime interaction was not significant for any outcomes. In models that included overall levels of anxiety, these relationships were maintained.

Conclusion

This is one of the largest studies to show that habitual sleep patterns are associated with real-world food choices. In particular, shorter sleep duration and tiredness/sleepiness are associated with more ready-made and fast food meals. It is possible that lack of sleep leads to worse food choices, or that stress leads to both lack of sleep and easier food options. Given the often poor nutritive value of foods consumed outside the home and pre-prepared foods, these associations may in part explain the influence of sleep on cardiometabolic risk factors.

Support

Dr. Grandner is supported by R01MD011600

1174 Assessing Sleep Disorders in Primary Care: A Provider Survey About the Importance of Sleep Health

Introduction

Conditions commonly managed by primary care providers (PCPs) such as depression, diabetes, and heart disease, commonly co-occur with sleep disorders. If PCPs could readily identify comorbid sleep disorders in this context, it may provide a pathway to more effective management of both types of disorders. Currently, it is unknown what might encourage or discourage PCPs from routinely screening their patients for sleep disorders.

Methods

PCPs from UPENN and GHS completed surveys regarding sleep health. The 30-item instrument comprised demographic, 14 VAS (0%-100%=strongly disagree-strongly agree), 4 open-ended, 3 yes/no, and 2 multiple-choice questions.

Results

Ninety-nine PCPs responded and were predominately female (61% F, 37%M, 2% other), Caucasian (81%), on-average 45yrs old (25-70) and in primary care for 16yrs (1-43). Fifty-six percent were MDs, 21%DOs, 17%PAs, and 6%NPs. PCPs rated sleep disorders as highly important for cardiopulmonary, mental, and general health (85, 84, & 83%), with no difference (per linear regression, p>0.05) according to system or provider characteristics. PCPs reported high importance for knowing about and diagnosing sleep disorders (88% & 82%) within their practices. Lower comfort levels were reported for discussing (78%) sleep disorders, overseeing/following (62%), diagnosing (60%), or treating (48%) patients. Eighty percent of PCPs stated an efficient sleep disorders screener would be useful for their practice; this perception varied (per logistic regression) according to provider credentials (Wald=0.037) and Hispanic/Latino ethnicity (Wald=0.025). PCPs reported time constraints limit their responsiveness to sleep disorders

Conclusion

A large disparity exists between the importance PCPs place on sleep disorders and their low comfort levels with following, diagnosing, and treating sleep disorders. PCPs endorsed the need to have available an efficient sleep disorders screener to use in their practice.

Support

No funding was received for this study.

Comparing the 5-Year Diabetes Outcomes of Sleeve Gastrectomy and Gastric Bypass: The National Patient-Centered Clinical Research Network (PCORNet) Bariatric Study

Question

How do type 2 diabetes (T2DM) outcomes compare across the 2 most common bariatric procedures?

Findings

In this cohort study of 9710 adults with T2DM who underwent bariatric surgery, most patients who had Roux-en-Y gastric bypass or sleeve gastrectomy experienced T2DM remission at some point over 5 years of follow-up. Patients who had Roux-en-Y gastric bypass showed slightly higher T2DM remission rates, better glycemic control, and fewer T2DM relapse events than patients who had sleeve gastrectomy.

Meaning

Understanding diabetes outcomes of different bariatric procedures will help surgeons and patients with diabetes make informed health care choices.

Importance

Bariatric surgery can lead to substantial improvements in type 2 diabetes (T2DM), but outcomes vary across procedures and populations. It is unclear which bariatric procedure has the most benefits for patients with T2DM.

Objective

To evaluate associations of bariatric surgery with T2DM outcomes.

Design, Setting, and Participants

This cohort study was conducted in 34 US health system sites in the National Patient-Centered Clinical Research Network Bariatric Study. Adult patients with T2DM who had bariatric surgery between January 1, 2005, and September 30, 2015, were included. Data analysis was conducted from April 2017 to August 2019.

Interventions

Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG).

Main Outcome and Measures

Type 2 diabetes remission, T2DM relapse, percentage of total weight lost, and change in glycosylated hemoglobin (hemoglobin A_1c).

Results

A total of 9710 patients were included (median [interquartile range] follow-up time, 2.7 [2.9] years; 7051 female patients [72.6%]; mean [SD] age, 49.8 [10.5] years; mean [SD] BMI, 49.0 [8.4]; 6040 white patients [72.2%]). Weight loss was significantly greater with RYGB than SG at 1 year (mean difference, 6.3 [95% CI, 5.8-6.7] percentage points) and 5 years (mean difference, 8.1 [95% CI, 6.6-9.6] percentage points). The T2DM remission rate was approximately 10% higher in patients who had RYGB (hazard ratio, 1.10 [95% CI, 1.04-1.16]) than those who had SG. Estimated adjusted cumulative T2DM remission rates for patients who had RYGB and SG were 59.2% (95% CI, 57.7%-60.7%) and 55.9% (95% CI, 53.9%-57.9%), respectively, at 1 year and 86.1% (95% CI, 84.7%-87.3%) and 83.5% (95% CI, 81.6%-85.1%) at 5 years postsurgery. Among 6141 patients who experienced T2DM remission, the subsequent T2DM relapse rate was lower for those who had RYGB than those who had SG (hazard ratio, 0.75 [95% CI, 0.67-0.84]). Estimated relapse rates for those who had RYGB and SG were 8.4% (95% CI, 7.4%-9.3%) and 11.0% (95% CI, 9.6%-12.4%) at 1 year and 33.1% (95% CI, 29.6%-36.5%) and 41.6% (95% CI, 36.8%-46.1%) at 5 years after surgery. At 5 years, compared with baseline, hemoglobin A_1c was reduced 0.45 (95% CI, 0.27-0.63) percentage points more for patients who had RYGB vs patients who had SG.

Conclusions and Relevance

In this large multicenter study, patients who had RYGB had greater weight loss, a slightly higher T2DM remission rate, less T2DM relapse, and better long-term glycemic control compared with those who had SG. These findings can help inform patient-centered surgical decision-making.

Correction to: Understanding the Bariatric Patient Perspective in the National Patient-Centered Clinical Research Network (PCORnet) Bariatric Study

In the original article the list of author names and affiliations were incorrect.

Older People Who Are Frequent Users of Acute Care: A Symptom of Fragmented Care? A Case Series Report on Patients' Pathways of Care

Older frequent users of acute care can experience fragmented care. There is a need to understand the issues in a local context before attempting to address fragmented care. 0.5% (n=61) of the population in a defined local government area were identified as having ≥4 unplanned emergency department (ED) presentations/ admissions to an acute-care hospital over 13 months. A retrospective case-series study was conducted to examine detailed pathways of care for 17 patients within the identified population. The two dominant presentation reasons were clinical symptoms associated with a declining/significant loss of capacity in fundamental self-care activities and chronic cardiac/respiratory conditions. Of patients discharged home, 21% of discharge letters were delayed >7 days and only 19% received a written discharge plan. Half of community dwelling patients received home nursing and/or assistance. Frequent users of acute care can experience untimely hospital communication and may require more coordinated care provided in the community to assist self-care and manage chronic conditions.

Peak Pruritus Numerical Rating Scale: psychometric validation and responder definition for assessing itch in moderate-to-severe atopic dermatitis

BACKGROUND

Moderate-to-severe atopic dermatitis (AD) is a chronic disease characterized by intense, persistent and debilitating itch, resulting in sleep deprivation, signs of anxiety and depression, impaired quality of life and reduced productivity. The Peak Pruritus Numerical Rating Scale (NRS) was developed and validated as a single-item, patient-reported outcome (PRO) of itch severity.

OBJECTIVES

To describe the content validity and psychometric assessment (test-retest reliability, construct validity, known-groups validity, sensitivity to change) of the Peak Pruritus NRS, and to derive empirically a responder definition to identify adults with a meaningful change in itch.

METHODS

Content validity was assessed through in-depth patient interviews. Psychometric assessments used data from phase IIb and phase III dupilumab clinical trials and included test-retest reliability, construct validity, known-groups validity and sensitivity to change in patients with moderate-to-severe AD.

RESULTS

Interview participants indicated that the Peak Pruritus NRS was a relevant, clear and comprehensive assessment of itch severity. Peak Pruritus NRS scores showed large, positive correlations with existing PRO measures of itch, and weak or moderate correlations with clinician-reported measures assessing objective signs of AD. Peak Pruritus NRS score improvements were highly correlated with improvements in other itch PROs, and moderately correlated with improvements in clinician-reported measures assessing objective signs of AD. The most appropriate threshold for defining a clinically relevant, within-person response was ≥ 2-4-point change in the Peak Pruritus NRS.

CONCLUSIONS

The Peak Pruritus NRS is a well-defined, reliable, sensitive and valid scale for evaluating worst itch intensity in adults with moderate-to-severe AD.