bluuebunny/crossref_metadata_2025 huggingface dataset:
0688 Nocturnal pain and its association with quality of life in women: data from the Epidemiologic Sleep Study (EPISONO)
Authors: Lucena Leandro , Lavigne Gilles , Fabbro Cibele , Andersen Monica , Tufik Sergio , Hachul Helena
Published: May 2023

Introduction

It is known that poor sleep is related to pain, even though this relationship is not fully understood. Women with pain present alterations in sleep pattern and reduced quality of life, but little is known about the negative effects of nocturnal pain on these outcomes. This study aimed to evaluate and compare the levels of anxiety, depression, and fatigue in women with pain during the night with those without pain. We hypothesize that pain perception is associated with worsening fatigue and mood outcomes.

Methods

This cross-sectional study used data from the 2007’s Epidemiological Study of Sleep (EPISONO). A total of 574 women aged 20-80 years participated in the EPISONO, and 244 women met the inclusion criteria of our study, 85 in the pain group and 171 in the control group. Participants were categorized into the pain group if they responded positively to the following questions: i) they generally had pain, according to the Pre-Sleep Questionnaire (PSQ), and ii) pain usually interfered with sleep 3 or more times a week, according to the Pittsburg Sleep Quality Index (PSQI). Participants who responded negatively to these questions were allocated to the control group. All of them underwent a full night laboratory polysomnography, and answered questionnaires related to fatigue, depression, anxiety, and quality of life.

Results

Significantly higher levels of fatigue (5.4 times), anxiety and depression were observed in the pain group, as well as significantly lower values in all domains of quality of life, compared to the control group. The presence of pain at night was also correlated with levels of anxiety and depression in the psychological (Rs=-0.463, -0.607, respectively) and social (Rs=-0.423, -0.438, respectively) domains of quality of life.

Conclusion

The presence of pain at night in women is related to a decrease in quality of life and can lead to worsening mood disorders and fatigue. Our results show the importance of investigating pain and its consequences, as well as the interference in women's sleep patterns.

Support (if any)

Associação Fundo de Incentivo à Pesquisa (AFIP), Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) - Finance Code 001, and Conselho Nacional de Pesquisa (CNPq).
0689 Nurses and Sleep: The Relationship Between Patient-Related Stressors and Sleep Quality
Authors: Sedano Brandon Fernandez , Shurovi Sumayya , David Michelle , Cornelius Talea , Schwartz Joseph , Abdalla Marwah
Published: May 2023

Introduction

Poor sleep quality in nurses is linked to worse psychological health. Identifying which occupational stressors may impact nurses’ sleep quality and psychological health may provide an opportunity for intervention. Patient-related stressors such as worrying about and/or an inability to help patients recover or survive hospitalization have a negative impact on a nurses’ psychological health. It remains unclear if patient-related stressors also impact nurses’ sleep quality. We examined if more patient-related stressors are associated with lower sleep quality in nurses.

Methods

The Worksite Blood Pressure Study is a multi-site study investigating psychosocial factors and ambulatory blood pressure. The study recruited 472 participants from 10 New York City worksites including 105 nurses during 3 waves over 11 years. The current analysis was restricted to 82 nurses at Wave 3. Participants completed the Nurses’ Stress Inventory Questionnaire which assessed the frequency and severity of stressful situations at work and a sleep questionnaire. Items on patient-related stressors and sleep quality were examined with higher scores indicating more stress and worse sleep quality, respectively. A linear regression model was specified predicting sleep quality from stressful patient interactions; participants answering at least 8 of the 16 items querying these interactions were included in the analysis. Age, race/ethnicity, religion, personal income, employment tenure, and years of education were included as covariates.

Results

Participants (N=82) were 96.3% female, 30.5% Black, 4.8% Hispanic/Latinx, 75.6% Christian. Mean age was 40.2 years (SD = 7.5), mean years of education was 15.4 (SD = 2.2), mean employment tenure was 8.3 years (SD = 6.7), and median personal income was $55,000 (Range $17,500, $95,000). Mean sleep quality was 8.9 (SD = 2.6). Nurses who reported greater frequency and severity of patient-related stressors had significantly worse sleep quality, B = 1.79, 95% CI 0.20, 3.37, p = 0.028. Sensitivity analyses restricting the analysis to nurses with no missing data on stressful interactions replicated these results, B = 2.22, 95% CI 0.34, 4.09, p = 0.022.

Conclusion

Patient-related stressors were associated with lower sleep quality in nurses. Efforts to increase support to nurses who experience patient-related stressors may help improve nurses’ sleep quality and possibly psychological health.

Support (if any)

P01HL47540
0690 People without any sleep complaints achieve results that exceed the cut-off thresholds in standardized sleep assessment
Authors: Smułek Daria , Gustavsson Katarzyna , Wichniak Adam
Published: May 2023

Introduction

With increasing prevalence of sleep problems in the general population, a question arises on whether standardized clinical sleep assessment shows results exceeding the cut-off thresholds in healthy subjects who do not report any sleep complaint. The aim of this ongoing study is to assess a sample of healthy subjects who report good sleep quality, for each gender in age groups 18-30, 31-40, 41-50, 51-60, 61-75 years old.

Methods

Up to now 70 healthy subjects have taken part in the project (38 females, 32 males, mean age 39.5 ±12.5, median 37 years). Assessment of sleep, and mental health related symptoms was performed using actigraphy, sleep diaries and clinical ratings scales: the Insomnia Severity Index (ISI), Epworth Sleepiness Scale(ESS), Morningness Eveningness Questionnaire(MEQ), Ford Insomnia Response to Stress Test (FIRST), International Physical Activity Questionnaire (IPAQ), STOP-Bang Questionnaire, Sheehan Disability Scale (SDS), Quick Inventory of Depressive Symptoms (QIDS-16SR), Generalized Anxiety Disorders Scale (GAD7), World Health Organization Quality of Life Scale (WHOQOL-BREF).

Results

In ISI scale 20 subjects (28,6%) reported mild and 2 subject (2,8%) moderate insomnia symptoms. In ESS 7 subjects (10.0%) were found to have mild, 5 (7,1%) moderate and 3 (4,3%) severe excessive daytime sleepiness. Anxiety symptoms reported 15 (21,4%) subjects and depressive symptoms 18 (22,9%) subjects. Moderate for risk for sleep apnea was found in 9 (12,8%) and high in one (1,4%) subject. In sleep diaries sleep latency above 30 minutes was found in 4 (5,6%) subjects, WASO above 30 minutes in 7 (10.0%) subjects, total sleep time below 6,5 hours in 22 (31,4%) subjects. Average time in bed was 474 ±55 minutes and average sleep efficiency 86,8 ±7,5%. ISI correlated with FIRST (r=0.496, p< 0.001), GAD-7 (r=0.445, p< 0,001), QIDS-SR16 (r=0,483, p< 0.001), sleep latency (r=0,313, p< 0,05), WASO (r=0,270, p< 0,05). ESS corelated with FIRST (r=0.316, p< 0,01), GAD-7 (r=0,275, p< 0,05).

Conclusion

Substantial proportion of subjects from the general population who did not initially report any sleep complaints obtained results exceeding suggested threshold in standard clinical scale and sleep parameters below normal valse in sleep diaries. Poor sleep indices are most related to scales measuring stress, anxiety and depressive symptoms.

Support (if any)
0692 Relationships Between Sleep and Social Cognitive Biases in Schizophrenia-Spectrum and Bipolar Disorders
Authors: Springfield Cassi , Hammer Lillian , Pinkham Amy , Moore Raeanne , Ackerman Robert , Harvey Philip , Depp Colin , Bonfils Kelsey
Published: May 2023

Introduction

People with schizophrenia-spectrum disorders (SSDs) and bipolar disorders (BDs) experience difficulty with social cognition, or the mental processes that underlie social interactions, but determinants of social cognitive impairment are still under investigation. Research suggests that poor sleep quality is related to reduced social cognitive ability in BDs, but it is unclear if sleep quality is related to social cognition in SSDs and if sleep may be related to different types of social cognition (e.g., emotion recognition, biases) in different ways. This study aimed to examine relationships between sleep and different types of social cognition in SSDs and BDs. Given known relationships between blaming and untrustworthiness biases and paranoia in these populations, paranoia was also examined as potential mediator of these relationships.

Methods

Participants (SSDs n=91; BDs with psychotic features n=87) completed tasks of social cognitive ability (e.g., facial and multi-modal emotion recognition, attributional bias, untrustworthiness bias). Participants self-reported their sleep quality. Paranoia was assessed via clinical interview.

Results

In the BD group, poor sleep quality (r=-.23, p=.04) and shorter sleep duration (r=-.25, p=.02) were associated with a bias towards untrustworthiness. For those with SSDs, increased use of sleep medication was associated with poorer multi-modal emotion recognition (r=-.22, p=.04). Additionally, poor sleep quality and overall poor sleep were associated with increased blaming (r=.22, p=.03; r=.21, p=.04) and untrustworthiness biases (r=-.24, p=.03; r=-.24, p=.03) in this group. Higher daytime tiredness was also associated with untrustworthiness bias (r=-.23, p=.03) in SSDs. Regarding mediation results, paranoia did serve as a mediator in the relationships between sleep and blaming and untrustworthiness biases across the sample.

Conclusion

Results suggest that poor sleep quality is linked to increased attributional and untrustworthiness biases, and that these relationships may be at least partially explained by paranoia symptoms. Of note, however, is that indirect effect sizes in mediation models were small. Contrary to expectations, poor sleep quality was not consistently associated with reduced social cognitive ability in the current sample. Findings from the current study require further exploration and replication.

Support (if any)

This work was supported by the National Institute of Mental Health (grant number R01 MH116902-04 awarded to C.A.D).
0695 The Association Between Social Support at Work and Sleep Quality
Authors: Shurovi Sumayya , David Michelle , Sedano Brandon Fernandez , Cornelius Talea , Schwartz Joseph , Abdalla Marwah
Published: May 2023

Introduction

Social support, including support received by coworkers, is associated with one’s emotional well-being. Poor sleep quality among employees is associated with worse employee health, increased workplace injury and is a growing occupational health problem. Social support at home is known to positively impact sleep quality. However, whether social support at work affects sleep quality is unknown. We examined whether social support at work is associated with sleep quality.

Methods

The Worksite Blood Pressure study is a multi-site study of psychological factors and ambulatory blood pressure. The study recruited 472 participants without major cardiovascular disease from 10 New York City worksites during 4 waves over 11 years. The current analysis was restricted to 189 employed participants at Wave 4 and provided complete data. Participants completed the Job Content Questionnaire which assessed psychosocial and social characteristics of jobs, including social support received from coworkers and supervisors, and a sleep questionnaire. The sleep questionnaire assessed sleep quality, self-reported sleep duration, alertness, and sleep habits. For this analysis, items related to sleep quality were summed. Higher scores indicated worse sleep quality. A linear regression model was specified predicting sleep quality from social support at work. Study site, age, race/ethnicity, marital status, total number of people at home, and years of education were included as covariates.

Results

Of the 189 participants, 72.5% were male, 16.4% were Black, 7.4% were Hispanic/Latinx, and 73.0% were married. Mean age was 50.1 years (SD = 7.0), mean years of education was 17.8 (SD = 3.2), and median number of people at home was 3 (Range 0, 6). Mean support at work was 23.3 (SD = 3.9) and mean sleep quality was 8.6 (SD = 4.4). Social support at work was not significantly associated with sleep quality, B = 0.12, 95% CI -0.29, 0.05, p = 0.16. Sensitivity analyses that examined support from supervisors and from coworkers separately were also not significant, p > 0.20.

Conclusion

Social support at work was not significantly associated with sleep quality in our cohort. Factors beyond social support at work should be investigated to evaluate their associations with employees’ sleep quality.

Support (if any)

P01HL47540
0696 The Moderating Role of Sleepiness among Intraday Passive and Active Suicidal Ideation
Authors: Bishop Todd , Porter Andrew
Published: May 2023

Introduction

Disrupted sleep has been linked to suicidal thought and behavior. Less is known regarding underlying mechanisms of this relationship. A more nuanced understanding of the link between sleep and suicide may help inform treatment decisions and the development of prevention and intervention strategies. We examine prior day sleepiness as a moderator to the relationship between passive and active suicidal ideation (SI).

Methods

Young adults (mean age=21.04; SD=2.22) endorsing SI (n=59) at least twice in the past two weeks were enrolled in a trial examining potential iatrogenic effects of the ecological momentary assessment (EMA) of SI. A baseline battery collected data on past suicidal thought and behavior, demographics, and psychological distress. EMA surveys were administered randomly five times per day over four weeks and assessed sleepiness and current emotional state including occurrence and severity of SI and passive/active ideation.

Results

Altogether, 835 daily average EMA entries were utilized in the present analysis. A significant relationship (p<.05) was observed between sleepiness and passive SI and its impact on the intensity and duration of SI. Specifically, the association between passive and active SI was stronger on days that participants endorsed greater sleepiness. There was also a significant interaction such that one’s desire to die and a low desire to stay awake significantly interacted (p<.05) to predict same-day perceived controllability of SI. Meaning that when participants had a lower desire to stay awake, there was a stronger relationship among perceived ability to control one’s SI and lower desire to live.

Conclusion

This study examined the impact of daily sleepiness on relationships among passive and active SI among young adults endorsing suicidal thought. Findings indicate that the relation between daily passive and active SI severity grows stronger the sleepier one is relative to their average level of sleepiness. Future studies should incorporate objective measures of sleep to further explore these findings and clinical implications.

Support (if any)

This study was funded by the American Psychological Foundation. This work was also supported, in part, by the VA Center of Excellence for Suicide Prevention. Authors’ views do not necessarily represent those of the Department of Veterans Affairs or the United States Government.
0699 Longitudinal Assessment of Buprenorphine Effectiveness for Severe Restless Legs Syndrome and Dopaminergic Augmentation
Authors: Berkowski Joseph Andrew , Wang Lu , Mehra Reena
Published: May 2023

Introduction

Opioids are a consensus second-line treatment for moderate-to-severe restless legs syndrome (RLS). Due to its partial mu-opioid receptor agonist mechanism, buprenorphine (bup) has lower risk of respiratory depression, euphoria, and dependence than full-agonist opioids. We hypothesize that with long-term administration for severe RLS, bup is both effective and well-tolerated and can facilitate successful weaning off dopamine agonists (DA) for patients with augmentation.

Methods

We conducted a longitudinal examination of a retrospective cohort of patients prescribed bup over a 21-month period by a tertiary RLS specialist. Patient-reported outcomes were administered through patient-completed electronic health record-based questionnaires or by clinician interview: International RLS Study Group(IRLS-SG,primary outcome), Clinical Global Impressions of Improvement(CGI-I), Epworth Sleepiness Scale(ESS), Insomnia Severity Index(ISI), Patient Health Questionnaire(PHQ-9), and Patient-Reported Outcomes Measurement Information System-Sleep Disturbance domain(PROMIS-SD). A linear mixed model assuming compound symmetry correlation structure was used (least square means,95%CI) to test the change from baseline to 6-week, 3-month, 6-month, and 1-year intervals, and the final visit, irrespective of time from baseline, with adjustment of age, sex, other RLS meds at final visit, and administration of iron infusion.

Results

55 patients (56.4% female, 64.9±12.1 years) started bup for RLS, and 42(76.3%) remained on bup at the final visit. IRLS-SG was 27.8(25.3,30.3) at baseline and was significantly reduced at every interval (p of trend < 0.001), including 11.4(7.4,15.4) at 1 year. Of the 39(70.9%) patients that were on a DA with augmentation at baseline, 32(82.1%) had discontinued DAs with 5(12.8%) on a reduced dose at the final visit. Of those remaining on bup at the final visit, 93.8% were CGI-I responders, There was a statistically significant longitudinal trend in 1-year improvement in ESS:9.9(8.0,11.8) to 6.9(4.5,9.4),p=0.003, ISI:18.0(15.9,20.1) to 15.0(11.6,18.3),p=0.048, PHQ-9:10.4(8.2,12.5) to 6.1(3.6,8.6),p< 0.001, and PROMIS-SD:63.0(60.2,65.7) to 53.8(49.8,57.8),p< 0.001. 13(23.6%) discontinued bup with nausea, cognitive complaints, and dizziness as the most common side effects.

Conclusion

In this largest cohort to date to examine buprenorphine in severe RLS, our findings show buprenorphine markedly reduced RLS symptoms, effectively enabled the elimination of dopamine agonists in patients with augmentation, improved sleep and other health quality measures, and was tolerated comparably to other RLS medications.

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0703 The burden of obstructive sleep apnoea and periodic limb movements during sleep on symptoms of parasomnia
Authors: Bikov Andras , Aleem Muhammad Saad , Morris Bryn
Published: May 2023

Introduction

Both obstructive sleep apnoea (OSA) and periodic limb movements during sleep (PLMS) may trigger arousals which could induce parasomnias. However, the burden of OSA and PLMS in parasomnia is not fully understood. The aim of the study was to understand the prevalence of OSA and PLMS and their association with symptoms of parasomnia in patients referred with parasomnia for an inpatient polysomnography (PSG).

Methods

In this retrospective project we analysed demographics, medical history and PSG data of 94 patients with parasomnia. The relationship between symptoms of parasomnia, OSA and PLMS were analysed with logistic regression analyses. Data are expressed as odds ratio /95% confidence intervals/.

Results

Forty-seven patients were diagnosed with OSA and 19 with PLMS. Parasomnia symptoms consisted dream enactment (n=28), abnormal movements (n=35), sleep talking (n=36), confusional arousals (n=27), sleep walking (n=36), night terrors (n=18), nightmares (n=15), sleep eating (n=8) and sexsomnia (n=2). Based on symptoms and PSG results, 45 were diagnosed with REM-parasomnia, 63 with non-REM parasomnia, 14 had overlap (both REM and non-REM parasomnia). Interestingly, non-REM parasomnias were inversely related to both OSA (-0.89 /-1.77-0.00/) and PLMS (-1.60 /-2,69- -0.55/, p< 0.01). More particularly, OSA was less prevalent in patients with night terrors (-1.52 /-2.72- -0.32, p< 0.01), whilst PLMS was more prevalent in patients with dream enactment (1.26 /0.21-2.30/, p=0.03), but was less prevalent in patients with nightmares (-2.30 /-5.164-0.56/, p=0.03), and with sleep walking (-1.96 /-3.49- -0.42/, p< 0.01).

Conclusion

Both OSA and PLMS are prevalent in patients with parasomnia, however their association with specific diseases and symptoms is less evident. Further studies are necessary to understand if they could be treatable traits in parasomnias.

Support (if any)
0708 Systematic Review of Behavioral Treatments for NREM Parasomnias
Authors: Mundt Jennifer , Schuiling Matthew , Warlick Chloe , Wescott Annie , Hagenaars Muriel , Furst Ansgar , Baron Kelly
Published: May 2023

Introduction

NREM parasomnias are often benign and transient, requiring no formal treatment. However, parasomnias can also be chronic, disrupt sleep quality, and pose a significant risk of harm to the patient or others. Numerous behavioral strategies have been described for the management of NREM parasomnias, but there have been no published comprehensive reviews. This systematic review was conducted in order to summarize the range of behavioral interventions and their efficacy.

Methods

We conducted a systematic search of the literature to identify all publications describing behavioral treatment of NREM parasomnias (confusional arousals, sexsomnia, sleepwalking, sleep terrors, sleep-related eating disorder, parasomnia overlap disorder). The search was conducted on March 10, 2021 in the following databases: Ovid (MEDLINE), Cochrane Library databases (Wiley), CINAHL (EBSCO), and Web of Science (Clarivate). The search yielded 2411 records. After removing duplicates, 1703 unique records were screened. This yielded 159 publications for full-text review. While reviewing those publications, an additional 83 were identified for screening. Based on the full-text reviews, a total of 66 publications were included in the systematic review, including manuscripts in English (n=63), Dutch (n=2), and German (n=1).

Results

Most included manuscripts were case studies, case series, or retrospective chart reviews. There were only three randomized controlled trials. Children (< 18 years) were included in 33 publications and adults were included in 36. Numerous behavioral strategies were reported, the most common being hypnosis (n=33) and various types of psychotherapy (n=26). Additional interventions included sleep hygiene (n=15), education/reassurance (n=13), relaxation (n=10), scheduled awakenings (n=9), and sleep extension or scheduled naps (n=8). In many studies, multiple interventions were trialed in combination. Length of follow-up varied considerably both within and between studies (range=0-9 years). Outcome measures were inconsistent across studies and some included only qualitative descriptions. Quantitative outcomes included the frequency of symptoms and patient ratings of symptom severity.

Conclusion

This review highlights the wide breadth of potential interventions for managing NREM parasomnias without medication. Randomized controlled trials are needed to determine which interventions are most efficacious, including which are best for particular disorders or ages. Future trials should include standardized quantitative measures of symptoms in order to allow comparison across trials.

Support (if any)
0709 Chronotype characteristics in restless legs syndrome
Authors: Lee Wankiun , Jung Ki-Young
Published: May 2023

Introduction

There are many people with a late chronotype in restless legs syndrome(RLS) patients. This phenomenon may be caused by sleep disturbance due to lower extremity symptoms of RLS, or it may be caused by some disease-specific characteristic of RLS, involving the circadian system. The aim of this study is to estimate the cause of this phenomenon.

Methods

This study is a retrospective study and was performed on 100 RLS patients without other major sleep disorders and 51 control subjects. Patients taking hypnotics such as benzodiazepines, melatonin, and zolpidem were also excluded. A survey on various sleep questionnaire scores was made for RLS patients. The questionnaire scores between the two groups were compared, and the collected data were analyzed with a significance level of 0.05.

Results

When the severity of RLS was evaluated by the IRLS score and the proportion of patients with late chronotype was checked by severity, it was 31.1% in the mild group, 41.7% in the moderate group, and 52.6% in the severe group(p=0.420). When the patient group with mild severity was compared with the entire patient group, the PSQI level was 82.0% of the total patient group(p=0.026).

Conclusion

RLS patients are more likely to have a late chronotype than those without RLS. The higher the severity of RLS symptoms, the higher the rate of having a late chronotype. Therefore, it could be inferred that the late chronotype identified in RLS patients was secondary to sleep disturbances caused by RLS symptoms.

Support (if any)
0716 Quality of Life in Idiopathic REM Sleep Behavior Disorder and Isolated REM Sleep Without Atonia
Authors: Barone Daniel , Sarva Harini , Wang Fei , Wu Zhenxing , Krieger Ana , Henchcliffe Claire
Published: May 2023

Introduction

Idiopathic rapid eye movement (REM) sleep behavior disorder (iRBD) can affect quality of life (QOL) for both patient and bed partner; isolated REM sleep without atonia (iRSWA) has been less well-studied. We aimed to investigate whether QOL changes over time in those with either iRBD or iRSWA, as well as compare these changes to one another. Additionally, we attempted to demonstrate whether certain QOL changes were associated with phenoconversion to neurodegenerative illness.

Methods

We prospectively analyzed data from the “REM Sleep Behavior Disorder Associations with Parkinson’s Disease Study (RAPiDS)” cohort both at baseline and then at follow-up evaluations. We utilized the Neuro-QOL self-reported questionnaire to ascertain subjects’ level of QOL.

Results

There were 6 with iRSWA and 33 with iRBD, with an average age of 61.9 ± 13.0 years, with 13 women and 26 men. Significant QOL changes were found in both iRSWA and iRBD group. Among those who phenoconverted, fatigue and social functioning were the main QOL issues that that worsened over time.

Conclusion

This is the first time the Neuro-QOL has been studied in iRBD and iRSWA. QOL can be affected in both conditions; fatigue and social functioning seem to be of particular importance as they may be associated with phenoconversion.

Support (if any)

Grant from a private individual
0719 Association of subjective-objective discrepancy in sleep duration with all-cause mortality in community-dwelling older men
Authors: Utusumi Tomohiro , Yoshiike Takuya , Kaneita Yoshitaka , Aritake-Okada Sayaka , Matsui Kentaro , Nagao Kentaro , Saitoh Kaori , Otsuki Rei , Shigeta Masahiro , Suzuki Masahiro , Kuriyama Kenichi
Published: May 2023

Introduction

There is evidence for a mismatch between subjective and objective sleep durations not only in individuals with insomnia but also in healthy individuals . However, it is unclear how such discrepancy impacts long-term health outcomes. This study investigated whether and how the discrepancy between subjective and objective sleep duration affected all-cause mortality in a sample of community-dwelling older adult men, aged ≥ 65 years.

Methods

We conducted a secondary analysis of data obtained via the Osteoporotic Fractures in Men Sleep Study, a community-based, longitudinal, observational, and multicenter study. We included data from 2,674 individuals who underwent an in-home polysomnography, completed morning surveys to assess subjective sleep duration during the polysomnography, and for whom survival or death data were available. We assessed the longitudinal association between misperception index (MI), calculated as MI = (objective sleep duration – subjective sleep duration) / objective sleep duration, and all-cause mortality. MI was treated as both a continuous and categorical predictor: the lowest (≤ -0.19; the overestimation of sleep duration) and highest MI quartiles (> 0.08; the underestimation of sleep duration) were compared to the interquartile range of MI (-0.19 <, ≤ 0.08 ).

Results

During the follow-up with a mean (standard deviation) of 10.8 (4.2) years, 1,596 deaths (59.7%) were observed. As a continuous variable, MI showed a negative association with all-cause mortality after adjusting for multiple covariates, including polysomnography-measured objective sleep duration (fully adjusted hazard ratio [HR], 0.69; 95% confidence interval [CI], 0.56–0.84). As a categorical variable, the lowest MI quartile (vs. the interquartile MI range) was associated with increased mortality (fully adjusted HR, 1.28; 95% CI, 1.12–1.46), whereas the highest MI quartile was not associated with mortality (fully adjusted HR, 0.97; 95% CI, 0.85–1.11).

Conclusion

The subjective overestimation (“reverse” misperception) of sleep duration, may be a risk factor for all-cause mortality in older men. Further investigations are needed to examine physiological mechanisms through which subjective overestimation of sleep duration leads to negative long-term health outcomes.

Support (if any)

This work was supported by the Ministry of Health, Labor and Welfare, Government of Japan (Grant numbers #19FA1009 and #21FA1002).
0721 Power Nap or Cognitive Trap? Role of Age in Associations Between Napping and Cognition
Authors: Nowakowski Lauren , Costa Amy , McCrae Christina , Curtis Ashley
Published: May 2023

Introduction

How napping is associated with cognition is currently unclear with past work indicating napping benefits cognition for young adults and inconsistent findings regarding cognition in older adults. The present study improved upon previous literature by examining how age moderates associations between napping behaviors across a full week and both subjective and objective cognition across the adult lifespan.

Methods

Cognitively healthy adults aged 18-82 (N=134, Mage=41.43, SD=22.14, 115 females) completed assessments of napping habits across 7 days (naps per week, duration), and subjective cognition [Cognitive Failures Questionnaire (CFQ) total, sub-scores of CFQ-memory, CFQ-distractibility, and CFQ-blunders]. A sub-set of participants (N=105) also completed objective cognitive tasks: Stroop (inhibition, attention, processing speed), Posner Cueing (attentional orienting), Sternberg (working memory), and Wisconsin Card Sorting (executive function). Multiple regression and Johnson-Neyman analyses evaluated the moderating impact of age on associations between napping and cognition, controlling for sex, anxiety and depression symptoms, and sleep and pain medication usage.

Results

Age moderated the relationship between nap duration and CFQ-total (R2-change=.02, p=.04), CFQ-memory (R2-change=.04, p=.01), and CFQ-blunders (R2-change=.06, p=.01). Specifically, longer nap duration was associated with fewer global cognitive complaints at age 20 and below (B=-.08, SE=.04, p=.049), more memory complaints at age 69 and above (B=.08, SE=.04, p=.05), as well as more blunder complaints at age 47 and above (B=.05, SE=.02, p=.048).

Conclusion

Findings suggest longer naps are associated with worse subjective cognition in older adults and better subjective cognition in younger adults. Similar patterns were not observed in middle-aged adults or for objective cognition. More work is needed to understand how the potential cognitive restorative impact of napping in younger adults may be disrupted in older adults. Given known associations between subjective cognition and future cognitive impairment, prospective studies should determine if napping is a key indicator of potential future cognitive decline in aging adults and explore underlying age-related mechanisms in this relationship such as systemic inflammation and changes in

Support (if any)

This work was supported by the American Academy of Sleep Medicine Foundation (NCT0282642; AASM Award #: 212-FP-19 PI: Curtis, a foundation of the American Academy of Sleep Medicine).
0723 Slow wave activity surrounding K-complexes is associated with long-term all-cause mortality in a large community-dwelling cohort
Authors: Valencia Daphne , Schoenholz Reagan , Bischoff Giles , Berkalieva Asem , Wickramaratne Sajila , Mullins Anna , Kam Korey , Varga Andrew , Ayappa Indu , Rapoport David , Parekh Ankit
Published: May 2023

Introduction

Sleep fragmentation is thought to be associated with adverse long-term consequences including mortality. However, conventional metrics of sleep fragmentation such as time spent in non-REM, REM sleep stages have been inconsistently associated with long-term consequences of sleep fragmentation. Recent studies suggest that morphological features of K-complexes might better describe sleep fragmentation as they are sensitive to effects of sleep disruption and better correlate with short-term outcomes such as daytime sleepiness. We previously demonstrated that the slow wave activity (SWA) surrounding K-complexes (∆SWAK) was a strong predictor of sleepiness in a cohort of sleep apnea subjects, mediated in part by its association with sleep fragmentation, however its association with long-term consequences of sleep fragmentation is not well known.

Methods

We analyzed nocturnal polysomnography (NPSG) data from Sleep Heart Health Study (1995-1998), a well-characterized cohort examining the cardiovascular consequences of sleep-disordered breathing. The primary quantitative EEG (C3-A2) metrics were: SWA (%relative power in 0.5-4 Hz), K-complex density (number/min of N2), and ∆SWAK. K-complexes were detected automatically using previously published open-source method (DETOKS, Parekh et. al., 2015) during stage N2 of sleep only. All EEG metrics were divided into quartiles to explore potential non-linear associations. Death from any cause up until 2011 (mean follow up of 11 years) was the primary outcome. Cox-regression models were used to assess the relationship between EEG metrics and all-cause mortality.

Results

After accounting for missing data, 3,909 NPSG’s with at least 6h of usable EEG were available for analysis (age=64±11 yrs., 53.4% female). In multivariate Cox-regression models adjusted for age, gender, race, severity of sleep apnea, total sleep time, time spent in stage N2, and smoking, all-cause mortality was significantly associated with the highest quartile of SWA (HR_q4=0.77 [0.6-0.9], p=0.01), highest two quartiles of ∆SWAK (HR_q3=0.8 [0.6-0.9], p=0.04; HR_q4=0.6 [0.5-0.8], p< 0.001).

Conclusion

Quantitative EEG measures predict mortality in a large community-dwelling cohort. Specifically, slow-wave activity surrounding K-complexes appear to be strongly associated with all-cause mortality beyond the effect of known covariates. Combined with our previous studies, our data suggest that slow-wave specific EEG measures are predictive of short- and long-term consequences of sleep fragmentation.

Support (if any)

AASM Foundation BS-233-20, NIH-K25HL151912, R21HL165320
0726 Agreement Between an Electroencephalography-Measuring Headband and Polysomnography in Older Adults with Sleep Disturbances
Authors: Miner Brienne , Pan Yulu , Burzynski Chase , Iannone Lynne , Knauert Melissa , Gill Thomas , Yaggi H
Published: May 2023

Introduction

Polysomnography (PSG) is the gold standard for objective sleep measurement but may not reflect habitual sleep patterns, especially in older adults with sleep disturbances. We compared measurements from an electroencephalography(EEG)-measuring headband, averaged over seven nights, to one night of home-based polysomnography.

Methods

In a prospective, observational study among 33 community-living adults ≥65 years reporting symptoms of insomnia and/or daytime sleepiness ≥once/week, we collected objective measures of total sleep time [TST], sleep latency [SOL], wake after sleep onset [WASO], and sleep efficiency [SE] from an EEG-headband (Dreem; Paris, France) and home-based PSG (NOX-A1 Sleep System; Reykjavik, Iceland). Measures from the EEG-headband were averaged over seven days and compared to measures from one night of PSG. Pearson correlation coefficients compared agreement between the EEG-headband and PSG for TST, SOL, WASO, and SE. Two-sample paired T-tests examined mean differences within subjects for TST, SOL, WASO, and SE between the headband and PSG.

Results

The mean age was 75 (±6) years, 76% were women, mean scores for the Epworth Sleepiness Scale and Insomnia Severity Index were 6 (±4) and 13 (±4), respectively, and the mean AHI was 19 (±16) events/hr. Correlations for TST, SOL, WASO, and SE between the EEG-headband and PSG were 0.58, 0.51, 0.48, and 0.64, respectively (p values < 0.01). On average, EEG-headband values for objective sleep measures were lower than PSG values. The mean differences for the EEG-headband and PSG within subjects for TST, SOL, WASO, and SE were 25 minutes (p=0.04), 15 minutes (p=0.06), 3 minutes (p=0.74), and 5 percent (p=0.02), respectively.

Conclusion

Among community-dwelling older adults with insomnia and daytime sleepiness, objective sleep measures from an EEG-headband, averaged over a week, were moderately correlated with values from one night of home-based PSG. While further validation of the EEG-headband is needed, these results suggest it may be inappropriate to infer habitual sleep patterns from PSG measures in older adults with sleep disturbances.

Support (if any)

Claude D. Pepper Older Americans Independence Center at Yale (P30AG021342), the Patterson Trust, and the National Institute on Aging (R03AG073991, K76AG074905).
0727 Association of sleep quality with memory functions among dementia-free, middle- and older-age, rural Indians
Authors: Sundarakumar Jonas , Rai Pooja , Divya N M , Issac Thomas
Published: May 2023

Introduction

Sleep is known to be involved in cognitive processes, such as memory consolidation. Poor sleep is a potential risk factor for dementia. However, whether it is associated with decreased memory functions among dementia-free individuals is not well known. This study aims to investigate the effect of sleep quality on memory functions among middle and older-age adults from a rural Indian population.

Methods

Participants were dementia-free, rural Indians (≥ 45 years) recruited as part of an ongoing, prospective, aging cohort study, namely Srinivaspura Aging, NeuroSenescence, and COGnition (SANSCOG) study. Cross-sectional (baseline) data on sleep quality was obtained using Pittsburgh Sleep Quality Index (PSQI). Memory functions (at baseline) were assessed using subtests, namely immediate recall, delayed recall, name-face association, semantic fluency, phonemic fluency, and semantic association, from a culturally validated computerized neurocognitive test battery. Clinical Dementia Rating (CDR) was used to classify subjects based on their cognitive status into cognitively healthy (CDR=0) and MCI (CDR=0.5). Linear regression models, unadjusted and adjusted with cognitive status, age, gender, and depression, were used for analysis.

Results

In the unadjusted linear regression model 1, we found no association between sleep quality and the different subtests of memory. However, in model 2 (adjusting for cognitive status), sleep quality in persons with MCI was significantly associated with memory functions. Model 3 (model 2 + age) found that sleep quality in higher ages in MCI explained a significant variance in the association between sleep and subtests of memory function compared to cognitively healthy individuals. Model 4 (model 3 + gender) suggested that with increasing age, gender was significantly associated with sleep quality and memory among individuals with MCI compared to cognitively healthy individuals. Further, model 5 (model 4+ depression) found that depressed individuals with MCI showed a significant association between sleep quality and memory functions compared to those without depression.

Conclusion

When adjusted for cognitive status, age, gender and depression, there was significant association of sleep quality and memory functions, pointing to the important role of sleep in memory functions among middle and older-aged individuals without dementia.

Support (if any)

SANSCOG study is funded through the Centre for Brain Research by Pratiksha Trust
0729 Grandparents Raising Grandchildren: Does Caregiving Status Moderate the Relationship between Stress and Sleep
Authors: Stearns Melanie , McGovney Kevin , Curtis Ashley , Lee Soomi , Haley William , Szalacha Laura , McCrae Christina
Published: May 2023

Introduction

The close relationship between high stress and poor sleep is well known. Less is known whether this relationship is stronger for a certain population group who may experience more stress. Grandparents responsible for raising their grandchildren are such a vulnerable group, as increased caregiving responsibilities are associated with increased stress levels. To test this hypothesis, we examined whether grandparent caregiving status moderated the relationship between subjective stress and sleep.

Methods

The sample was a subset of individuals recruited in the second wave of the MIDUS biomarkers project completed in 2009 who answered the sleep, caregiving, and stress variables of interest. Participants included grandparents who reported having been responsible for the care of their grandchildren for at least 1 year (N=63, age M=61.80, 64% female) and grandparents who were not responsible for their grandchildren (N=423, age M=62.98, 56.2% female). Multiple regressions (SPSS PROCESS) examined whether caregiving status (1=yes, 0=no) moderated associations between subjective stress (Perceived Stress Scale) and sleep (subjective Sleep Onset Latency-SOL and sleep quality) over the past month. Analyses controlled for age and gender.

Results

Caregiving status interacted with stress (t(1, 484)=3.81, p=.04) in its association with SOL (R2=.15, p=.001). Specifically, increased stress was associated with greater SOL in caregiving grandparents and to a lesser (but not significant) extent in non-caregiving grandparents (Z =1.49, p=.13). Caregiving status interacted with stress (t(1, 484)=5.76, p=.02) in its association with sleep quality (R2=.33, p< 001). Specifically, increased stress was associated with worse sleep quality in caregiving grandparents and to a less extent in non-caregiving grandparents (Z =2.67, p=.01).

Conclusion

These results suggest that caregiving status may contribute to an increase in the positive relationship between subjective stress and sleep problems. Future research should utilize longitudinal and experimental methodology to determine the causality of these relationships as well as examine physiological measures of stress. In addition, studies should investigate whether addressing stress in behavioral sleep treatments may improve caregiving grandparents’ sleep.

Support (if any)

National Institute on Aging (P01AG020166, R37AG027343; McCrae, PI: R01AG061976)
0730 Polysomnographic characteristics among transgender adults; Influence of gender-affirming hormone therapy
Authors: Romero Ronald Gavidia , Padia Hiral , Matlen Lisa , Hershner Shelley
Published: May 2023

Introduction

Gender differences in polysomnographic characteristics (PC) among cisgender people may be influenced by gonadal hormones. Data on PC among transgender people (TP) receiving or not gender-affirming hormone therapy (GAHT) is sparse. This study aimed to describe PC among TP and explore associations between gender identity (GI), GAHT, and PC.

Methods

This cross-sectional study identified TP at a large academic sleep medicine center through medical record review. We included TP aged ≥18 years with available polysomnography data. The sample was stratified by GI (transfeminine and transmasculine) and further classified by GAHT use. Descriptive statistics were calculated for GI and GAHT groups. Linear regression models adjusted for age, obstructive sleep apnea, and depression diagnoses were utilized to examine associations between GI, GAHT, and PC (total sleep time [TST], sleep onset latency, rapid eye movement sleep latency [REMSL], arousal index, wake after sleep onset [WASO], sleep stage rapid eye movent [REM], non-REM [N] 1, 2, and 3 percentage, sleep efficiency, and periodic limb movement index [PLMI]).

Results

Seventy-seven individuals met inclusion criteria. Of these, 52% were transfeminine, mean age was 39.2±13.3 years, mean body mass index was 35.1±9.0 Kg/m2, and 56% used GAHT. Transmasculine people had significantly higher stage N3% (13.9±13.6 vs 7.7±10.0%), and lower PLMI (3.5±5.8 vs 10.6±18.6/h) compared to transfeminine participants. Among transmasculine people, REMSL was shorter in participants using GAHT compared to those not on GAHT (145.0±66.9 vs 217.1±104.1 minutes). In transfeminine people, stage N3% and REMSL were increased in those on GAHT compared to individuals not on GAHT (10.6±11.5 vs 4.9±7.7%; 214.8±126.9 vs 133.6±85.5 minutes, respectively), although not statistically significant. Adjusted analysis showed associations between transmasculine identity and decreased TST (β=-42.8, 95% CI [-84.7, -0.9] minutes), feminizing GAHT use and longer REMSL (β=84.2, 95% CI [0.1, 168.4] minutes), and suggested decreased REMSL and WASO with masculinizing GAHT use (β=-59.4, 95% CI [-134.2,15.3]; β=-28.7, 95% CI [-72.5, 15.0] minutes respectively).

Conclusion

This report highlights differential associations between GI, GAHT, and PC in TP. Despite some enhanced PC, transmasculine identity significantly decreased TST. In addition, feminizing GAHT contributed to mixed PC outcomes, while masculinizing GAHT appeared to improve them.

Support (if any)

None
0735 Restorative sleep restores sleep loss and excessive time in bed in middle-aged and older adults
Authors: Yoshiike Takuya , Utusumi Tomohiro , Matsui Kentaro , Nagao Kentaro , Saitoh Kaori , Otsuki Rei , Aritake-Okada Sayaka , Suzuki Masahiro , Kuriyama Kenichi
Published: May 2023

Introduction

Associations of sleep duration with health outcomes could differ depending on whether sleep is restorative. Age-related changes in the relationship between sleep need and sleep opportunity could also influence these associations.

Methods

Using data from 5804 participants of the Sleep Heart Health Study, a multicenter population-based prospective cohort study, we examined the longitudinal association of feeling rested after sleep combined with in-home polysomnographymeasured total sleep time (TST) or time in bed (TIB) with allcause mortality.

Results

A total of 223 (7.1%) and 991 (37.0%) deaths were reported in 3128 middle-aged (40–64 years) and 2676 older adults (≥ 65 years) with a mean (standard deviation) age of 54.5 (6.6) and 73.3 (5.7) years at baseline over a median (interquartile range) follow-up time of 12.3 (11.3–13.5) and 11.3 (8.2–12.2) years, respectively. Among middleaged adults, compared with the interquartile TST range (331 to < 414 min) with feeling rested, the lowest TST quartile (< 331 min) with feeling unrested was associated with higher mortality (adjusted hazard ratio [aHR], 1.54; 95% confidence interval [CI] 1.01–2.33); the highest TST quartile (≥ 414 min) with feeling rested was associated with lower mortality, independently from health and sleep covariates (aHR, 0.55; 95% CI 0.32–0.97). Among older adults, TIB, but not TST, was consistently associated with mortality. Compared with the interquartile TIB range (404 to < 482 min) with feeling rested, the highest TIB quartile (≥ 482 min) with feeling unrested was associated with higher mortality (aHR, 1.57; 95% CI 1.23–2.01).

Conclusion

The results suggest the role of restorative sleep in differentiating the effects of sleep duration on mortality outcomes for middle-aged and older adults. Our findings further suggest that there is a need to change the way to optimize sleep hygiene according to age groups: in middle-aged adults maintaining a substantial amount of sleep is more critical, whereas in older adults optimizing sleep opportunity is more critical to determine the sleep–mortality relationship.

Support (if any)

This work was supported by the Ministry of Health, Labor and Welfare, Government of Japan (Grant numbers #19FA1009 and #21FA1002).