Publications by Year: 2024

This scoping review evaluated the efficacy and potential of web-based interventions for substance use disorders and mental health conditions. The studies comprise randomized controlled trials, pilot trials, and effectiveness trials. Web-based interventions consistently demonstrated significant reductions in substance use, improvements in mental health outcomes (e.g., PTSD, depression, anxiety), and enhancements in emotion regulation, help-seeking, and quality of life. Several studies found web-based interventions to be non-inferior or superior to traditional face-to-face treatments. Despite limitations in the current evidence base, such as methodological issues and lack of long-term follow-up, the findings highlight the promise of web-based interventions in expanding access to evidence-based care, particularly for underserved populations. Future research should focus on refining interventions, exploring novel technologies, and evaluating long-term effectiveness and cost-effectiveness. The integration of web-based interventions into healthcare systems has the potential to significantly impact public health by increasing treatment accessibility and improving outcomes for individuals with substance use disorders and mental health conditions.

Individuals with a history of incarceration face many barriers to accessing resources to meet their basic needs when returning to community settings. Digital health tools have potential to reduce health inequities by facilitating connections to health and social services, and peer support. This study aimed to employ a user-centered design approach to create a digital Personal Health Library (PerHL) for previously incarcerated individuals. The design process included in-depth interviews followed by rapid analysis, interpretation sessions, and user experience/user interface (UX/UI) design of a high-fidelity prototype. Semi-structured interviews were conducted with individuals with a history of incarceration (n=20) to understand their experience rejoining their communities. Findings highlight the need for an app that allows users to easily access resources for employment, housing, healthcare and medical needs, formal and informal support, and legal counsel.

Atopic dermatitis (AD) is a chronic inflammatory skin disorder characterized by persistent itching of the skin with its prevalence increasing in the United States. AD has a complex pathogenesis that remains to be fully resolved, though it is shown to involve immune dysregulation and skin barrier dysfunction, with multiple environmental and genetic factors implicated. The interplay between the immune system and environmental exposures can incite immune responses with the release of cytokines, IgE, eosinophils, and mast cells, which trigger symptoms of AD in susceptible patients. There are many therapies used in AD; however, the first-line treatment for flares continues to be corticosteroids. The broad range of therapies available for AD is associated with adverse effects, poor adherence, and financial burden, accentuating the need to assess alternative therapies. A promising alternative therapy is the catechin family, a group of flavonoids with a unique structure that has anti-inflammatory, antimicrobial, antioxidant, and skin barrier modulating properties. In this review, we describe the structure and related properties of catechins, their function, and how they can be utilized in the treatment of AD. Furthermore, we describe limitations associated with the use of catechins and the necessity of further research in this area. The function of catechins has been widely shown to modulate the inflammatory pathway and skin barrier dysfunction that have been implicated in AD and reduce symptoms. While catechins can mitigate symptoms and reduce associated inflammatory markers, further research is required to develop a therapy that retains the beneficial functions of catechins without increasing cytotoxicity.

Chronic kidney disease-associated pruritus (CKD-aP) is a prevalent and challenging symptom in patients with CKD and end-stage renal disease (ESRD). The aim of this review is to update existing evidence on the pathogenesis and treatments of pruritus in CKD and to shed light on areas that hold promise. The uncertain pathogenesis, and thus seemingly miscellaneous causes, identifies chronic itch as an important challenge in health care. A complex interaction of uremic toxin accumulation, micro and systemic inflammation, dysregulation of the opioid system, and mast cell activation may each contribute to the pathophysiology of CKD-aP. No highly satisfactory antipruritic therapeutics are available. Difelikefalin, considered to be a peripherally acting highly selective kappa-opioid receptor agonist, has been shown to have a positive impact on CKD-aP. Approved by the FDA in 2021 for intravenous administration, difelikefalin remains the most recent drug available. A developing area is that altered hemoglobin metabolism may lead to the activation of mas-related G protein-coupled receptors (MRGPRs). As this family of receptors is associated with itch, it is possible that drugs that target certain MRGPRs may be of future benefit in CKD-aP.

INTRODUCTION: High blood pressure (HBP) is an independent, modifiable driver of cardiovascular (CV) morbidity and mortality. Nocturnal hypertension and non-dipping of blood pressure (NdBP) may be early markers of HBP. Similar to patients with NdBP, individuals with non-dipping of heart rate (NdHR) during sleep have an increased risk of CV disease, CV events, and CV-related mortality. The aim of this analysis was to evaluate if cardiopulmonary coupling (CPC) analysis-derived sleep states [stable/unstable non-rapid eye movement (NREM) sleep] and concomitant heart rate (HR) changes can provide information about nocturnal blood pressure (BP).

METHOD: Plethysmogram (pleth) signals from the HeartBEAT study (NCT01086800) were analyzed for CPC sleep states. Included in the analysis are sleep recordings from participants with acceptable pleth-signal quality at baseline (n = 302) and follow-up (n = 267), all having confirmed CV disease or CV-disease risk factors. The participants had a high prevalence of obstructive sleep apnea (OSA), 98.4% with moderate-OSA [apnea-hypopnea index (AHI) ≥ 15) and 29.6% severe OSA (AHI ≥ 30). A "heart-rate module" was created to evaluate the utility of identifying patients more likely to have BP dipping during sleep. Patients who did not have a decrease of ≥10% in their BP from wake to sleep were defined as NdBP and NdHR if their heart rate during stable-NREM sleep was higher than during unstable-NREM sleep.

RESULTS: The most significant difference in minimum HR (HRmin) was observed when comparing BP dippers [56 ± 4 beats per minute (BPM)] and non-BP dippers (59 ± 4 BPM; p < 0.0001) during diastolic blood pressure in stable-NREM sleep. Higher HRmin were associated with an increased likelihood of being a non-dipper, with the strongest relationship with diastolic BP and stable-NREM sleep. Every increase of 1 BPM during stable-NREM sleep was associated with an  4.4% increase in the probability of NdBP (p = 0.001). Subjects with NdHR have higher mean BP during sleep and wake periods than HR dippers. When continuous positive airway pressure therapy is efficacious, and a dipping pattern is achieved-physical and mental health is improved.

CONCLUSION: HR analytics in relation to the sleep period and the CPC spectrogram-estimated sleep states can provide novel and potentially clinically useful information on autonomic health. HR dipping (or not) may be a useful screener of BP dipping or non-dipping to identify individuals who may benefit from a formal assessment of 24-h ambulatory BP. Such a stepped approach may enable a more practical and applicable approach to diagnosing HBP.

CLINICAL TRIAL REGISTRATION: The Heart Biomarker Evaluation in Apnea Treatment (HeartBEAT) study is registered at clinicaltrials.gov/ct2/show/NCT01086800.

Hypnagogia-the transitional state between wakefulness and sleep-is marked by "hypnagogic dreams," during which our brains tend to forge connections among concepts that are otherwise unrelated. This process of creating novel associations during hypnagogic dreams is said to contribute to enhancing creativity, learning, and memory. Recently, researchers have proposed that mind-wandering-a form of spontaneous thought that is freely moving and characterized by transitioning thought content-might be subserved by processes similar to those engaged during hypnagogia, and may serve similar creative functions. However, to date, the relationship between hypnagogia and mind-wandering remains poorly understood, which is likely due in part to the fact that research into hypnagogia requires time-consuming, cumbersome, and costly polysomnography. In light of this, the present study had two primary aims: first, to test a novel tool-called Dormio Light-for cueing and indexing hypnagogic dream content in a cost- and time-effective manner, with the ability for remote administration; second, to use this tool to examine any relations between hypnagogic dreams and mind-wandering (defined as "freely moving thought"). Participants (N = 80, with 34 females) completed a task in which our tool prompted them to engage in hypnagogia and, separately, mind-wandering, with instructions to think about a common everyday object (Tree or Fork) while experiencing these cognitive states. Following each state, participants reported thought content and completed phenomenological questionnaires. Providing an initial validation of our tool, we successfully cued hypnagogic and mind-wandering thought content that was specific to our cues (e.g., Tree), with our incubation-rate results comparable to those found in laboratory-based studies. Further, we found evidence for some phenomenological differences between hypnagogia and mind-wandering reports. Our study offers a novel, cost- and time-effective tool with which to remotely cue and index hypnagogia and mind-wandering, and sheds light on the relationship between hypnagogia and mind-wandering, thereby providing future directions for research into these two cognitive states.

Despite being the gold-standard treatment for obstructive sleep apnea (OSA), continuous positive airway pressure (CPAP) faces important challenges, particularly with patient adherence. Many individuals find CPAP difficult to tolerate due to noise, social inconveniences, characteristics inherently linked to their sleep disorder and side effects, including mask discomfort, air leaks, nasal congestion, and the unnatural sensation of exhaling against positive pressure. All this often leads to reduced usage, limiting CPAP's potential to deliver long-term health benefits. This review revisits the dynamics of pharyngeal collapse during sleep on PAP, offering a new interpretation that challenges the long-standing view that higher inspiratory pressure is required to maintain pharyngeal patency. Emerging evidence, combined with the knowledge from older studies, suggests that airway collapse often occurs near end-expiration, which may be the only time that substantial positive airway pressure is required. Efforts to improve CPAP compliance have reduced expiratory pressure, leading to the introduction of bilevel PAP (BPAP) and expiratory pressure relief algorithms, which may cause airway destabilization, without yielding the improvements in adherence that were initially anticipated. Thus, despite over three decades of innovation, which have also seen heated humidifiers and tubes, customized 3D-printed masks and auto-titrating PAP come to market, there has been limited success in systematically increasing long-term CPAP adherence rates. In response, we discuss novel approaches such as V . -Com® and KairosPAP™ (KPAP™), which reduce inspiratory pressure and, in the case of KPAP™, also much of expiratory pressure, returning to full pressure only at the end of expiration. Recent studies suggest these technologies improve comfort and reduce unintentional leaks and may lead to better adherence without sacrificing treatment effectiveness. This aligns with the hypothesis that stabilizing the airway during end-expiration may be key to enhancing CPAP comfort and adherence. In conclusion, while technological advancements have improved the CPAP experience, further progress will likely come from solutions that better address patient comfort with the applied pressure. KPAP™ is one such innovation with the potential to enhance adherence, but additional research is needed to fully understand its long-term impact and effectiveness in PAP therapy for OSA.

INTRODUCTION: This study evaluated the performance of a wrist-worn wearable, Verily Study Watch (VSW), in detecting key sleep measures against polysomnography (PSG).

METHODS: We collected data from 41 adults without obstructive sleep apnea or insomnia during a single overnight laboratory visit. We evaluated epoch-by-epoch performance for sleep vs. wake classification, sleep stage classification and duration, total sleep time (TST), wake after sleep onset (WASO), sleep onset latency (SOL), sleep efficiency (SE), and number of awakenings (NAWK). Performance metrics included sensitivity, specificity, Cohen's kappa, and Bland-Altman analyses.

RESULTS: Sensitivity and specificity (95% CIs) of sleep vs. wake classification were 0.97 (0.96, 0.98) and 0.70 (0.66, 0.74), respectively. Cohen's kappa (95% CI) for 4-class stage detection was 0.64 (0.18, 0.82). Most VSW sleep measures had proportional bias. The mean bias values (95% CI) were 14.0 min (5.55, 23.20) for TST, -13.1 min (-21.33, -6.21) for WASO, 2.97% (1.25, 4.84) for SE, -1.34 min (-7.29, 4.81) for SOL, 1.91 min (-8.28, 11.98) for light sleep duration, 5.24 min (-3.35, 14.13) for deep sleep duration, and 6.39 min (-0.68, 13.18) for REM sleep duration. Mean and median NAWK count differences (95% CI) were 0.05 (-0.42, 0.53) and 0.0 (0.0, 0.0), respectively.

DISCUSSION: Results support applying the VSW to track overnight sleep measures in free-living settings. Registered at clinicaltrials.gov (NCT05276362).