0978 Snoo: A Wellness Device To Improve Infant Sleep

Introduction

One of the primary contributors to new parent sleep deprivation is infant sleep disturbances. Evidence shows that increasing sleep in infants has a positive effect on parental sleep. SNOO, a wellness device, was developed to provide sleeping babies 3 of the 5 S’s (safe swaddling, sound and swinging) in a response fashion (increasing levels of motion and white noise if babies cry) to soothe crying and improve infant sleep.

Methods

The current study compares infant sleep derived from SNOO to a reference group of a compilation of 13 peer reviewed studies of normative sleep data on sleep in traditional cribs/bassinets. Participants were 7157 babies using SNOO beginning within one week of birth and for at least 6 hours per night for 6 months. Sleep metrics calculated on a day to day basis include Longest Sleep Period: Maximum uninterrupted sleep at night (7 PM - 7 AM); Total Sleep Duration: Total time spent sleeping at night (7 PM - 7 AM); and Night Awakenings: Number of times parents attended to the baby (10 PM - 6 AM).

Results

Improvement in the longest sleep duration varied with age. Across the 6 month collection period, longest sleep period increased between 42 minutes - 2 hours 0 minutes and total sleep duration increased between 33 minutes - 1 hour 24 minutes. Babies in SNOO averaged one less waking per night compared to the reference population (1.09±.89 vs 1.89 ±1.1). The improvements in all three sleep metrics were statistically significant with p’s < 0.0005 across all ages from birth to 6 months.

Conclusion

This large-scale study suggests that infant sleep can be significantly improved by using SNOO compared to babies who slept in normal cribs or bassinets. We believe there are myriad areas of public health that may be positively impacted as a result of this significant level of improvement of infant sleep.

Support

Happiest Baby, Inc.

0531 Efficacy of a Single 4 Hour CBT-I Workshop in a Community Sample with Self-Reported Insomnia Symptoms

Introduction

Cognitive behavioral treatment for insomnia (CBT-I) is the first line of treatment for insomnia. However, experts have noted that the expanded use of CBT-I is limited by the small number of specialty-trained clinicians, as well as the duration and cost of individual treatment sessions (usually 6-8). One solution is a single-session educational group format delivered by a trained health educator rather than a licensed clinician. Our objective was to evaluate the efficacy of group CBT-I delivered by a Ph.D. level health educator to community dwelling individuals with self-reported insomnia symptoms.

Methods

Participants were referred from clinicians, our website, and social media postings. Participants completed the Insomnia Severity Index, provided information on type of sleep aid use and frequency, and the presence of co-morbid conditions prior to and 1-month post attendance of a single 4-hour CBT-I workshop.

Results

Participants (N = 31) were 58 ± 12 years of age (range 29 - 80); 11 Males, 20 Females; 90.6% white; 66% married; 71.8% at least a college graduate; and 34.3% had an average income of > $100K. Comorbidities included pulmonary disease (6%), GI disease (9.6%), endocrine disease (9.6%), and headaches (25.8%). Insomnia Severity Index scores significantly improved from baseline (19.6 ± 5.06) to 1-month (FU 13.7 ± 6.33) (t = 21.9, P < .001)). Similarly, frequency of sleep aid use significantly dropped (χ 2 = 105.7, p = .017). Subjective improvement in sleep was reported as the following: 12.5% much better, 56.3% better, 25% the same, and .03% worse.

Conclusion

These data indicate that a single 4-hour CBT-I workshop delivered by a health educator can significantly reduce insomnia symptoms, improve subjective sleep quality, and reduce sleep aid use among community dwelling adults with self-reported insomnia symptoms within 1-month. These data extend what has been shown primarily in older adults. That is, brief behavioral treatment for insomnia can be acceptable and efficacious to anyone reporting insomnia symptoms.

Support

The Insomnia Clinic

Towards global consensus on core outcomes for hidradenitis suppurativa research: an update from the HISTORIC consensus meetings I and II

BACKGROUND

A core outcomes set (COS) is an agreed minimum set of outcomes that should be measured and reported in all clinical trials for a specific condition. Hidradenitis suppurativa (HS) has no agreed-upon COS. A central aspect in the COS development process is to identify a set of candidate outcome domains from a long list of items. Our long list had been developed from patient interviews, a systematic review of the literature and a healthcare professional survey, and initial votes had been cast in two e-Delphi surveys. In this manuscript, we describe two in-person consensus meetings of Delphi participants designed to ensure an inclusive approach to generation of domains from related items.

OBJECTIVES

To consider which items from a long list of candidate items to exclude and which to cluster into outcome domains.

METHODS

The study used an international and multistakeholder approach, involving patients, dermatologists, surgeons, the pharmaceutical industry and medical regulators. The study format was a combination of formal presentations, small group work based on nominal group theory and a subsequent online confirmation survey.

RESULTS

Forty-one individuals from 13 countries and four continents participated. Nine items were excluded and there was consensus to propose seven domains: disease course, physical signs, HS-specific quality of life, satisfaction, symptoms, pain and global assessments.

CONCLUSIONS

The HISTORIC consensus meetings I and II will be followed by further e-Delphi rounds to finalize the core domain set, building on the work of the in-person consensus meetings.

Impact of immunogenicity on pharmacokinetics, efficacy and safety of adalimumab in adult patients with moderate to severe chronic plaque psoriasis

BACKGROUND

Adalimumab is a tumour necrosis factor-alpha antibody approved for treatment of moderate to severe chronic plaque psoriasis.

OBJECTIVE

To characterise population pharmacokinetics of adalimumab 40 mg every other week dosing regimen and impact of immunogenicity on pharmacokinetics, efficacy and safety in psoriasis patients.

METHODS

Patients were enrolled in a Phase 3 study comprising a 16-week double-blind, placebo-controlled period, a 17-week open-label period for Week 16 Psoriasis Area and Severity Index (PASI) 75 responders, and a 19-week double-blind, placebo-controlled period for Week 33 PASI 75 responders. Serum adalimumab and anti-adalimumab antibody (AAA) concentrations were measured and a population pharmacokinetic model devleoped to identify patient/disease factors affecting adalimumab pharmacokinetics. Impact of immunogenicity on treatment efficacy and safety was also assessed.

RESULTS

Week 33 mean adalimumab concentration was 5.2 μg/mL. Week 16 responders had higher adalimumab concentrations than non-responders (6.3 vs. 2.2 μg/mL). Bodyweight and study were significant covariates in population pharmacokinetic model with weight accounting for 19% and 29% of variability in adalimumab clearance and volume of distribution, respectively. A total of 8.8% of adalimumab-treated patients tested AAA positive and had twofold higher adalimumab clearance. PASI 75 response rate was comparable between AAA+ and AAA- patients at Weeks 33 and 52 (Week 33: 36% vs. 22.5%, Week 52: 21.1% vs. 17.8%) and adverse events incidence was similar between the two groups.

CONCLUSIONS

Patient weight and study significantly affect adalimumab clearance and volume of distribution in psoriasis patients. Development of AAAs result in lower adalimumab exposure and efficacy with no effect on adverse events incidence.

Polymorphisms in the vicinity of the hypocretin/orexin are not associated with human narcolepsy

Human narcolepsy/cataplexy is associated with reduced hypocretin (orexin) transmission. A common preprophypocretin (HCRT) polymorphism (-909C/T) was identified and tested in 502 subjects (105 trio families, 80 Caucasian narcolepsy cases, and 107 Caucasian control subjects). This polymorphism was not associated with the disease. The promoter and 5' untranslated (5'URT) regions of the HCRT gene (-320 to +21 from ATG) were also sequenced in 281 subjects. None of the subjects carried -22T, a rare 5'UTR polymorphism previously reported to be associated with narcolepsy. The HCRT locus is not a major narcolepsy susceptibility locus.

Low cerebrospinal fluid hypocretin (Orexin) and altered energy homeostasis in human narcolepsy

Hypocretins (orexins) are hypothalamic neuropeptides involved in sleep and energy homeostasis. Hypocretin mutations produce narcolepsy in animal models. In humans, narcolepsy is rarely due to hypocretin mutations, but this system is deficient in the cerebrospinal fluid (CSF) and brain of a small number of patients. A recent study also indicates increased body mass index (BMI) in narcolepsy. The sensitivity of low CSF hypocretin was examined in 38 successive narcolepsy-cataplexy cases [36 human leukocyte antigen (HLA)-DQB1*0602-positive] and 34 matched controls (15 controls and 19 neurological patients). BMI and CSF leptin levels were also measured. Hypocretin-1 was measurable (169 to 376 pg/ml) in all controls. Levels were unaffected by freezing/thawing or prolonged storage and did not display any concentration gradient. Hypocretin-1 was dramatically decreased (<100 pg/ml) in 32 of 38 patients (all HLA-positive). Four patients had normal levels (2 HLA-negative). Two HLA-positive patients had high levels (609 and 637 pg/ml). CSF leptin and adjusted BMI were significantly higher in patients versus controls. We conclude that the hypocretin ligand is deficient in most cases of human narcolepsy, providing possible diagnostic applications. Increased BMI and leptin indicate altered energy homeostasis. Sleep and energy metabolism are likely to be functionally connected through the hypocretin system.

Complex HLA-DR and -DQ interactions confer risk of narcolepsy-cataplexy in three ethnic groups

Human narcolepsy-cataplexy, a sleep disorder associated with a centrally mediated hypocretin (orexin) deficiency, is tightly associated with HLA-DQB1*0602. Few studies have investigated the influence that additional HLA class II alleles have on susceptibility to this disease. In this work, 1,087 control subjects and 420 narcoleptic subjects with cataplexy, from three ethnic groups, were HLA typed, and the effects of HLA-DRB1, -DQA1, and -DQB1 were analyzed. As reported elsewhere, almost all narcoleptic subjects were positive for both HLA-DQA1*0102 and -DQB1*0602. A strong predisposing effect was observed in DQB1*0602 homozygotes, across all ethnic groups. Relative risks for narcolepsy were next calculated for heterozygous DQB1*0602/other HLA class II allelic combinations. Nine HLA class II alleles carried in trans with DQB1*0602 were found to influence disease predisposition. Significantly higher relative risks were observed for heterozygote combinations including DQB1*0301, DQA1*06, DRB1*04, DRB1*08, DRB1*11, and DRB1*12. Three alleles-DQB1*0601, DQB1*0501, and DQA1*01 (non-DQA1*0102)-were found to be protective. The genetic contribution of HLA-DQ to narcolepsy susceptibility was also estimated by use of lambda statistics. Results indicate that complex HLA-DR and -DQ interactions contribute to the genetic predisposition to human narcolepsy but that additional susceptibility loci are also most likely involved. Together with the recent hypocretin discoveries, these findings are consistent with an immunologically mediated destruction of hypocretin-containing cells in human narcolepsy-cataplexy.

Transcutaneous temporary pacing in the operating room

The safety and efficacy of transcutaneous temporary pacing were assessed in 21 patients undergoing elective surgical procedures under general anesthesia. Complete capture was achieved in all patients. The pacing threshold was 50 mamp in two patients, 100 mamp in nine, and 200 mamp in ten. The threshold was influenced by electrode position and also, possibly, by age, heart size, and chest size. No adverse effects of pacing were encountered. Transcutaneous pacing is a rapid, safe, and effective means of temporary pacing in the operating room.

[Rheography in the periodontium. Preliminary report]

The authors describe rheography as a method for assessing the blood circulation in the periodontium. With regard to material expenditure, electrode design and application to the alveolar ridge and the data obtained, the experimental arrangement presented by the authors proved to be a rapidly applicable and informative method of investigation, the results from which will be reported later on.

[Notes on the current discussion on the etiology of periodontopathies]

The aetiology and the therapy of periodontal diseases are main points of stomatological research. As to the methodological approach to aetiological studies, the use of materialistic dialectic proves profitable. For example, conclusions as to therapy result from the exact analysis of and the distinction between the causes of a disease and the pathogenic factors. In this way the exact evaluation of the importance of the known pathogenic factors becomes possible. The concept of multicausality proves to be unfavourable for the orientation to priority problems in aetiological research.