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Background Perinatal TORCH infections (Toxoplasma gondii, rubella, cytomegalovirus [CMV], herpes simplex virus [HSV]) cause significant fetal and neonatal morbidity and mortality. While perinatal infections are associated with a variety of clinical manifestations in the fetus, they rarely cause isolated intrauterine growth restriction (IUGR). TORCH screens are often ordered to investigate isolated IUGR, but there is limited evidence to support screening for these infections in the absence of other ultrasound abnormalities. Methods A retrospective review of antenatal TORCH testing between January 2014 and December 2018 was carried out at two hospitals in Melbourne, Australia. Records were reviewed to identify indications for testing, serology results, and subsequent antenatal investigations. Neonatal outcomes were also evaluated. Serology performed for stillbirth or pregnancy losses were excluded. Results Medical records of 718 pregnancies were reviewed, representing 760 fetuses. 82.5% of screens were ordered in the third trimester, with 43.5% ordered after 32 weeks gestation. TORCH serology was performed for the following indications: isolated IUGR (71.2%), neurological abnormality (6.8%), echogenic bowel (3.4%), and maternal illness (1.7%). Screens ordered for isolated IUGR were positive in 7.4% (95% CI 5.5-10.0%). TORCH screening identified 49 positive maternal IgM results (CMV = 34, toxoplasma = 15) Two acute maternal infections during pregnancy were diagnosed (CMV = 1, toxoplasma = 1). Both were identified due to symptomatic maternal illness. There was one confirmed neonatal CMV infection. Eight women did not have follow-up to determine the significance of a positive IgM result. No TORCH screen changed maternal management or neonatal outcomes. Rubella IgM was ordered in 83.5% of women who had clearly documented evidence of prior rubella immunity. No acute HSV infections were identified. Conclusion Antenatal TORCH screening for IUGR is of minimal utility and is often performed as a reflex rather than in response to specific clinical syndromes. A more guided approach with selective testing is needed. Disclosures All Authors: No reported disclosures.

Introduction Despite a high prevalence of sleep problems, there is a gross shortage of sleep clinicians within the military health system. To increase access to care, a novel telehealth platform was designed to empower patients and clinicians to make evidence-based sleep treatment decisions. Here, we present initial results from the implementation of this novel sleep telehealth platform in two military treatment facilities (MTFs). Methods Participants (N=305) with sleep complaints were recruited remotely and/or in-person from two MTFs. Participants were predominately men (53.4%), who self-identified as White (55.4%) or Black (24.1%) race and were retired or active-duty military servicemembers (69%). Average age was 45.9 (SD=13.3) years. Participants completed a baseline assessment including standardized research questionnaires via a mobile application (WellTap®). During a 10-day remote monitoring assessment, participants completed daily sleep diaries and twice-daily mood/daytime function surveys, while wearing a commercial-off-the-shelf device (Fitbit®). A personalized sleep report including evidence-based treatment recommendations was provided. Participants completed a satisfaction survey regarding the remote monitoring assessment. Results The most commonly reported sleep problems were difficulty staying asleep (65%), insufficient sleep (61%), and snoring (40%). Most participants described their sleep quality as “a little good” (51%) or “not at all good” (27%). Thirty-nine percent of participants reported moderate to severe insomnia complaints, 38% reported moderate to severe excessive daytime sleepiness, and 22% reported moderate to severe depressive symptoms. In terms of satisfaction, participants reported the sleep assessments were “easy” to complete (92%) and would consider sleep telehealth approaches in the future (95%). The vast majority of participants preferred to continue with sleep telehealth and preferred to combine a mobile app and remote monitoring with either virtual or face-to-face provider support. Conclusion Patients at two military treatment hospitals reported high levels of satisfaction with a novel 10-day intensive remote monitoring assessment including a mobile health assessment and wrist-wearable device. Future studies should evaluate the clinical and economic impact of sleep telehealth and remote monitoring in the U.S. military. Support (if any) Department of Defense (W81XWH1990006) via the Medical Technology Enterprise Consortium) to the University of Maryland, Baltimore (PI: EMW).

Introduction Cognitive complaints are common among older adults with insomnia. However, previous research is inconsistent regarding the association between insomnia and objective cognitive function. The purpose of this study was to compare subjective and objective cognitive function between older adults with insomnia and healthy sleepers. We hypothesized that relative to healthy sleepers, older adults with insomnia would display diminished subjective and objective cognitive function as measured via multiple remote assessment methods. Methods Participants were recruited from an academic medical center through multiple pathways. Cognitive assessments were administered via several approaches. First, subjective cognitive function was assessed via the 5-item Alert Cognition subscale of the psychometrically derived Daytime Insomnia Symptoms Scale (DISS), completed via smartphone 4x/day throughout a two-week study period (i.e., 56 administrations over 14 days). Second, objective cognitive function was assessed via telephone using the Brief Test of Adult Cognition by Telephone (BTACT), which assesses memory, reasoning, verbal fluency, and executive function. Finally, the psychomotor vigilance task [PVT], Stroop test, and a task-switching exercise were administered remotely via participant’s home desktop computer. Results Participants included 31 older adults who met DSM-V diagnostic criteria for insomnia disorder (67.5 [sd 6.6] years) and 33 older adults without sleep disorders (70.5 [sd 5.7] years). Large between-group differences were observed in the Alert Cognition subscale of the DISS (p-values < 0.0001); compared to healthy sleeper controls, participants with insomnia reported worsened forgetfulness, concentration, alertness, clear-headedness, and cognitive effort. No between-groups differences were observed in any domain of the BTACT or PVT. A numeric but not statistically significant between-groups difference was observed in overall response speed (e.g., Incongruent Response Time) on the Stroop test (p-values > 0.125). Conclusion Remote assessment of cognition is feasible among older adults with insomnia. Significant differences in subjective but not objective cognitive function, likely due to low statistical power, as cognitive deficits in insomnia tend to have small effect sizes. Overall, findings highlight the importance of multimethod assessments of cognition in older adults with insomnia and need for large sample sizes when evaluating objective cognitive function. Support (if any) Research was supported by an investigator-initiated research award from Merck Investigator Studies Program (PI: EMW).