Sleep talking vs. sleep moaning: electrophysiological patterns preceding linguistic vocalizations during sleep

Sleep talking (ST) has been rarely studied as an isolated phenomenon. Late investigations over the psycholinguistic features of vocal production in ST pointed to coherence with wake language formal features. Therefore, we investigated the EEG correlates of Verbal ST as the overt manifestation of sleep-related language processing, with the hypothesis of shared electrophysiological correlates with wake language production.From a sample of 155 highly frequent STs, we recorded 13 participants (age range 19-30y, mean age 24.6 ± 3.3; 7F) via vPSG for at least 2-consecutive nights, and a total of 28 nights. We first investigated the sleep macrostructure of STs compared to 13 age and gender matched subjects. We then compared the EEG signal before 21 Verbal STs vs. 21 Non-verbal STs (moaning, laughing, crying, ...) in 6 STs reporting both vocalization types in Stage 2 NREM sleep.The 2x2 mixed ANOVA Group x Night interaction showed no statistically significant effect for macrostructural variables, but significant main effects for Group with lower REM (%), TST, TBT SEI and greater NREM (%) for STs compared to controls.EEG statistical comparisons (paired-samples Student's t-Test) showed a decrement in power spectra for Verbal STs vs. Non-verbal STs within the theta and alpha EEG bands, strongly lateralized to the left hemisphere and localized on centro-parietal-occipitals channels. A single left parietal channel (P7) held significance after Bonferroni correction.Our results suggest shared neural mechanisms between Verbal ST and language processing during wakefulness and a possible functional overlapping with linguistic planning in wakefulness.

Combination of Obstructive and Central Sleep Apnea as a Non-Sleepy Phenotype of Obstructive Sleep Apnea (OSA): A Case Report and Literature Review

Background and Objective: Co-occurring central sleep apnea (CSA) and obstructive sleep apnea (OSA) are a developing apprehension because many patients referred to sleep studies have co-morbidities such as cardiovascular and/or neurological disorders which increase the possibility of central and obstructive episodes. Here, we report a patient without excessive daytime sleepiness and a combination of CSA and OSA. Case Report: We present a 16-year-old boy with a history of snoring, poor quality of sleep, nightmare, sleep walking, and sleep talking since he was two-years old. His STOP-Bang score was 7. Standard attended polysomnography (PSG) with audio-video monitoring was performed. The PSG results contained Apnea Hypopnea Index (AHI): 30.2 (number of OSAs was 50 and number of CSAs was 49 during sleep). Then, a titration study was performed and continuous positive airway pressure (CPAP) setting as low as eight cmH2O was effective in eliminating obstructive events, but there was emerging CSAs in favour of Treatment Emergent CSA (TCSA). Conclusion: This case represents a non-sleepy phenotype of OSA in combination with many CSAs in PSG. We suggest that further studies be performed on the association between the concomitant presence of CSA and OSA among nonsleepy patients with OSA.

Chorea, Ataxia, and Disturbed Sleep

A 72-year-old man sought care for predominant choreiform movements, mild gait ataxia, urinary dysfunction, and abnormal nocturnal behaviors. Choreiform movements were nearly constant while awake, vanished during sleep, and predominantly involved his lower extremities and trunk. He also had urinary dysfunction, with urinary hesitancy and frequency. Sleep-related behaviors included sleep talking, sleep singing, sudden single-limb jerking movements, and complex hand movements. He also had daytime sleepiness. On neurologic examination, abnormal findings included postural instability at baseline with eyes open and a slightly wide-based tentative gait and inability to execute tandem walking. He had intermittent choreiform movements of the legs and the left shoulder. He also had occasional repetitive, periodic, voluntary-appearing, triple flexion–type movements of both legs. Overnight polysomnography was ordered to evaluate nocturnal movements. Polysomnography revealed rapid periodic leg movements of sleep and rapid eye movement sleep without atonia. Sleep architecture was mildly deranged, with electroencephalographic alpha intrusion throughout nonrapid eye movement sleep, as well as absent slow-wave sleep. Ferritin level was suboptimal. Evaluation of serum for autoimmune encephalitis demonstrated IgLON family member 5 antibody positivity by tissue immunofluorescence assay, confirmed by cell-based assay. The patient was diagnosed with IgLON family member 5 autoimmune encephalitis and symptomatic rapid eye movement sleep behavior disorder. The patient was instructed to maintain a safe sleep environment at home and to begin taking melatonin at bedtime. A therapeutic trial of intravenous methylprednisolone, together with mycophenolate mofetil, was followed by improvement in memory, confusion, and hallucinations, waking involuntary movements, bladder dysfunction, and sleep quality. Rapid eye movement sleep behavior disorder is a parasomnia characterized by rapid eye movement sleep without atonia, the loss or dysregulation of normal rapid eye movement sleep atonia, which is its pathophysiologic signature, and which is permissive for dream enactment behaviors during rapid eye movement sleep.

Sleep disorders in adolescent school children in Kochi: a cross sectional study

Background: Sleep disorders in children are often undiagnosed and can negatively impact their physical and psychological health. This study was done to estimate the prevalence of sleep disorders in adolescent school children and to examine the association between body mass index and sleep disorders.Methods: This cross-sectional study was conducted in 3 purposively selected schools in Kochi among children aged 13-17 years. Pediatric sleep questionnaire was distributed among 550 students of which 229 were received back. Weight and height of the children were recorded and the BMI was calculated. Data were analysed using SPSS, version 20, and Chi-square was done to determine association.Results: The mean age of the study population was 14.56±1.311 years with equal gender distribution. 59% had sleep disorders. Parasomnia was the most common (64%) sleep disorder. Sleep talking (36%) was the most common parasomnia. Out of the total 229 children, 60 had Excessive daytime sleepiness (26.3%). 18.4% had sleep related breathing disorder, 4.37% had insomnia, 5.3% had restless legs. Delayed sleep phase disorder was seen in 13 (5.7%) of the total 229 children. BMI below 5th percentile was significantly associated with insomnia. We did not find any significant association between BMI and other categories of sleep disorders.Conclusions: There is a high prevalence of sleep disorders among adolescent school children. Underweight in adolescents was associated with insomnia. There is a need for greater awareness of sleep disorders in children among parents and health care professionals.

856 Sleep-writing, sleep-talking in uncontrolled REM-predominant obstructive sleep apnea

Introduction Abnormal movements and behaviors during sleep are part of a larger group of nocturnal events that may occur during the sleep-wake cycle and/or the transitions into and out of sleep. We are presenting the case of OSA-related confusional arousals associated with sleep-writing and sleep-talking during REM-sleep. Report of case(s) 46 year old female with history of CAD, HTN, RLS, Anxiety, Depression, and REM predominant OSA (AHI of 2.9 per hour of sleep, REM AHI of 40 per hour of sleep, and oxygen saturation nadir of 91%), noncompliant with PAP therapy, returned to reestablish sleep medicine care and restart PAP therapy. The patient reported worsening of her OSA symptoms while being without PAP therapy. In addition to traditional OSA symptoms (snoring, frequent nighttime awakenings, restless legs, daytime sleepiness/fatigue), she reported episodes of sleep-talking, sleep-writing with demonstrated evidence of these events in her personal diary. She maintains a collective diary that incorporates her blood pressure readings, her weight loss accounts with records of meals in a day, as well as a separate log of letters that she will write and mail. In this diary, she has noticed sleep writing instances in each field, with no recollections subsequently on the act of writing them. The patient reported that these episodes of sleep writing would occur 3–4 times in a week, during this period of PAP noncompliance. Last reported instance of her sleep writing was October 2020. After re-initiation of PAP therapy, the patient has not reported further episodes of sleep-writing or sleep-talking. Conclusion The sleep-writing is a very rare clinical symptom in the presentation of REM-predominant OSA as well as in REM/NREM parasomnias. We were not able to come across a case of it in the sleep literature review. Sleep-talking is a well-documented phenomenon. Confusional arousals may be responsible for symptoms of sleep-writing and sleep-talking in this case. We may repeat a sleep study with split protocol and parasomnia montage using AutoBipap if needed to investigate further. Further research should be done to explore the nature and correlation of sleep-writing in clinical practice. Support (if any) N/A

629 Sleep problems among children and adolescents with epilepsy in Thailand: single-center cross-sectional study

Introduction Sleep problems are common in pediatric epilepsy and may influence seizure control, daytime performance, and quality of life. The aim of this study was to investigate parent-reported and self-reported sleep problems in a sample of children and adolescents with epilepsy in Thailand. Methods Epileptic children age 1–18 years and their parents in epilepsy clinic completed the Phramongkutklao Hospital Sleep disorders center Questionnaire, Sleep Related Breathing Disorder- Pediatric Sleep Questionnaire (SRBD-PSQ) Results A total of 59 participants with the mean age of 10.8 years completed the questionnaires. The most common sleep complaint was a disorder of maintaining sleep 36 (61.01%). Several sleep manifestations were detected including disorder of initiating sleep 14 (23.7%), snoring 29 (49.2%), leg kicking 16 (27.1%), sleep talking 19 (32.2%), sleep walking 4 (6.7%), teeth gliding 18 (30.5%), nightmares 15 (25%), night terrors 8 (13.5%) and nocturnal enuresis 16 (27.1%). The frequency of sleep disordered breathing problems (SRBD-PSQ >0.33) was 33.9%. Conclusion The prevalence of sleep problems among children with epilepsy in Thailand is high. Therefore, a highlighting should be given to address sleep in children and adolescents with epilepsy. Further studies are needed to evaluate the effects of antiepileptic drugs, type of seizure or associated factors on sleep disruption in this population. Support (if any) None

Monitoring Depression Trend on Twitter during the COVID-19 Pandemic: Observational Study (Preprint)

BACKGROUND The COVID-19 pandemic has severely affected people’s daily lives and caused tremendous economic loss worldwide. Anecdotal evidence suggests that the pandemic has increased the depression level among the population. However, systematic studies of depression detection and monitoring during the depression are lacking. OBJECTIVE This study aims (1) to develop a method to accurately identify people with depression by analyzing their tweets and (2) to monitor the population-wise depression level on Twitter. METHODS To study this subject, we design an effective regular expression-based search method and create by far the largest English Twitter depression dataset containing 2,575 distinct identified depression users (N=2,575) with their past tweets. To examine the effect of depression on people’s Twitter language, we train three transformer-based depression classification models on the dataset, evaluate their performance with progressively increased training sizes, and compare the model’s “tweet chunk”-level and user-level performances. Furthermore, inspired by psychological studies, we create a fusion classifier that combines deep learning model scores with psychological text features and users’ demographic information and investigate these features’ relations to depression signals. Finally, we demonstrate our model’s capability of monitoring both group-level and population-level depression trends by presenting two of its applications during the COVID-19 pandemic. RESULTS Our fusion model demonstrates an accuracy of 78.9% on a test set containing 446 people (N=446), half of which are identified as suffering from depression. Conscientiousness, neuroticism, appearance of first-person pronouns, talking about biological processes such as eat and sleep, talking about power, and exhibiting sadness are shown to be important features in depression classification. Further, when used for monitoring the depression trend, our model shows that depressive users, in general, respond to the pandemic later than the control group based on their tweets. It is also shown that three states of the United States - New York (NY), California (CA), and Florida (FL) - share a similar depression trend as the whole US population. When compared to NY and CA, people in FL demonstrate a significantly lower level of depression. CONCLUSIONS This study proposes an efficient method that can be used to analyze the depression level of different groups of people on Twitter. We hope this study can raise awareness among researchers and the general public of COVID-19’s impact on people’s mental health. The non-invasive monitoring system can also be rapidly adapted to other big events besides COVID-19 and might be useful during future outbreaks.

Sleep, social behavior and food consumption of schoolchildren of a large Brazilian city

Objective: To characterize sleep and associated factors to their inadequacy, mainly social behaviour and food consumption of children and adolescents. Design: Cross-sectional study. Setting: Sleep information, social behaviour (Strengths and Difficulties Questionnaire), food consumption, demography, nutritional status, lifestyle and biochemical tests were investigated. Participants: Schoolchildren of the 4th grade of the municipal school system of a large Brazilian city. Results: A total of 797 schoolchildren, 50.9% was female, median of 9.7 (9.5-10.0) y old and energy consumption of 1819.7 (1429.9-2334.2) kcal. It was identified 31.6% of overweight and 76.8% reported insufficient weekly practice of physical activity. It was observed a median of 9.6 (8.9-10.5) h of sleep (lower values on weekdays: 9.3 vs 10.5h, P<0.001). In addition, 27% of individuals with inadequate sleep (<9h) enjoy longer screen time daily (≥2h/day) (P=0.05), inadequate bedtime (>22h) or adequate wake-up time (5-7h), study in the morning (P<0.001) and never take a shower before school (P<0.001). There was 9.9% of the sample with poor and very poor sleep quality and a greater probability of always sleep talking, have difficulty getting to sleep and inadequate social behaviour between these in relation to those with positive quality of sleep. There was no association of sleep with the other variables investigated. Conclusions: Sleep impairment contributed to changes in sleep and social behaviour in schoolchildren. The findings of this study may reinforce the importance of developing actions to promote adequate sleep and lifestyle at school age.

1258 No Laughing Matter - Laughter Induced Syncope (Gelastic Syncope) Mimicking Cataplexy

Introduction Laughter is a common emotion and may rarely be a manifestation of neurological illnesses. It has been associated with cataplexy as well. Cataplexy is usually triggered by strong emotions. Gelastic syncope is an uncommon phenomenon which may be mistaken for cataplexy. We summarize 3 cases referred to the Sleep Medicine clinic for evaluation for Narcolepsy. Report of Case 55 yo male comes with 2 episodes of blacking out and falling down relating to episodes of laughter in 3 months. Patient describes loss of consciousness and no episodes of freezing. Reported 15 years of snoring and witnessed apneas along with grinding his teeth while sleeping. Polysomnogram revealed Obstructive Sleep Apnea (OSA) with an AHI of 20. 60 yo male comes with episodes of loss of consciousness over the past 6 months, including sitting in a chair, laughing, urinating, washing dishes while standing, expressing strong emotions (father’s funeral), etc. Also reports bugs crawling over his legs when trying to sleep, loud snoring and waking up choking while sleeping. Polysomnogram revealed OSA with an AHI of 20. 43 yo male comes 3 episodes of loss of consciousness, 2 of them related to laughing and the last one related to stretching his arms out. He passes out for 5-10 seconds at a time and a period of 20-30 seconds before passing out where he feels dizzy when he is unable to respond at this time, no post episode confusion. Positive on the Cataplexy Emotional Trigger Questionairre. Reported witnessed apneas, snoring and sleep talking. Polysomnogram revealed OSA, hence the Multiple Sleep Latency Testing ordered was not completed. Conclusion While the first two episodes point towards Gelastic Syncope based on symptoms, the third did warrant MSLT if there was no OSA on PSG. It is important to recognize gelastic syncope as an entity and differentiate it from cataplexy.