bluuebunny/crossref_metadata_2025 huggingface dataset:
1071 Subjective Measures Of Hyperarousal Predict Subjective Longitudinal And Retrospective Measures Of Sleep Quality In Individuals Exposed To Trauma
Authors: Kram Mendelsohn A , Daffre C , Oliver K I , Seo J , Lasko N B , Pace-Schott E F
Published: May 2020

Introduction

Hyperarousal and disturbed sleep are intrinsic symptoms of posttraumatic stress disorder (PTSD). We explored whether self-reported indices of hyperarousal predict longitudinally measured objective, subjective, and retrospective evaluations of sleep quality in trauma-exposed individuals.

Methods

Individuals exposed to a DSM-5 PTSD Criterion-A traumatic event within the past two years (N=130, 91 females), aged 18-40 (mean 24.43, SD 5.30), 51.54% of whom met DSM-5 criteria for PTSD, completed 14 days of actigraphy and sleep diaries. Participants also completed the PTSD Checklist for DSM-5 (PCL-5), the Clinician-Administered PTSD Scale (CAPS-5), published Hyperarousal (HAS) and Hypervigilance (HVQ) scales, and the Pittsburgh Sleep Quality Index (PSQI) (N=108-125 for different scales). Mean total sleep time (TST), sleep onset latency (SOL), sleep efficiency (SE) and sleep midpoint were calculated from actigraphy and subjective SOL, SE, number of awakenings, and time spent awake from diaries. Simple regressions were used to predict associations of the PCL-5, HAS, and HVQ scores with measures of sleep quality.

Results

Hyperarousal indices predicted diary but not actigraphy measures of sleep quality. Longer diary-reported SOL was predicted by higher scores for: PCL-5 total score (R=0.290, p=0.001), PCL-5 hyperarousal items without the sleep item (R=0.261, p=0.004), and HAS without sleep items (R=0.220, p=0.016). Diary-reported number of awakenings and wake time after sleep onset were predicted by higher HAS scores without the sleep question: (R=0.373, p<0.001; r=0.352, p<0.001). Similarly, all hyperarousal indices significantly predicted PSQI global score (PCL-5: R=0.482, p<0.001; PCL-5 hyperarousal: R=0.389, p<0.001; HVQ: R=0.214, p=0.017; HAS without sleep question: R=0.415, p<0.001).

Conclusion

Self-reported hyperarousal measures predict subjective longitudinal (especially SOL) and retrospective measures, but not objective measurements of sleep quality. Similar discrepancies between self-reported and objective measures of sleep quality have been reported in patients with insomnia disorder. Cognitive-behavioral therapy for insomnia may be especially effective in treating post-traumatic sleep disturbances.

Support

R01MH109638
1072 Post-traumatic Stress Disorder Is Associated With Increased Oscillatory Frequency Of Sleep Spindles
Authors: Wang C , Laxminarayan S , Ramakrishnan S , Dovzhenok A , Cashmere D , Germain A , Reifman J
Published: May 2020

Introduction

Patients with post-traumatic stress disorder (PTSD) often suffer from sleep disturbances. Sleep spindles are an electrophysiological hallmark of non-rapid eye movement sleep and believed to be involved in sleep protection and sleep-dependent memory consolidation. Here, we sought to examine whether sleep spindles are altered in PTSD and whether the findings are reproducible across nights and subsamples of the study population.

Methods

We obtained 64-channel electroencephalogram (EEG) recordings from 78 combat-exposed Veteran men with (n = 31) and without (n = 47) PTSD during two consecutive nights of sleep. We identified slow (10-13 Hz) and fast (13-16 Hz) sleep spindles during N2 and N3 sleep using an automatic algorithm and performed topographical analyses of spindle parameters (amplitude, duration, oscillatory frequency, and density) on both nights. To assess reproducibility, we used the first 47 consecutive participants (18 with PTSD) for initial discovery and the remaining 31 participants (13 with PTSD) for replication assessment.

Results

In the discovery analysis, compared to participants without PTSD, those with PTSD exhibited 1) increased oscillatory frequency of slow spindles over the antero-frontal regions on both nights (Night 1: p = .020, Cohen’s d = 0.92; Night 2: p = .014, Cohen’s d = 1.07) and 2) increased oscillatory frequency of fast spindles over the centro-parietal regions on the second night (p = .018, Cohen’s d = 0.76). Notably, these trends were preserved in the replication analysis. In contrast, we found no significant group differences in the amplitude, duration, or density of slow or fast spindles.

Conclusion

The elevated sleep-spindle frequency in PTSD may reflect reduced thalamocortical inhibition and, hence, deficient sleep protection. Our findings provide the basis for an initial understanding of sleep-spindle abnormalities in PTSD. The findings, if independently validated, may assist in the development of sleep-focused diagnostics and interventions for PTSD.

Support

This work was sponsored by U.S. Defense Health Program (grant No. W81XWH-14-2-0145) and managed by the U.S. Army Military Operational Medicine Program Area Directorate, Ft. Detrick, MD. The study was also supported by the Clinical and Translational Science Institute at the University of Pittsburgh (UL1 TR001857).
0109 Slow Wave Sleep Time and Its Oscillatory Features Show Opposite Associations with Emotional Memory Consolidation Following Stress
Authors: Denis D , Kim S Y , Kark S M , Daley R T , Alger S E , Kensinger E A , Payne J D
Published: May 2020

Introduction

Sleep and stress can both enhance emotional memory consolidation. During slow wave sleep (SWS), oscillatory features such as slow oscillations (SO), sleep spindles (SS), and critically, their coupling, are believed to facilitate consolidation. How they relate to emotional memory consolidation is less clear, and how stress interacts with these oscillations is unknown.

Methods

In this study, participants either underwent a psychosocial stressor (the Trier Social Stress Task; n = 32) or a control task (n=32). Next, they encoded 150 neutral, negative, and positive images while undergoing fMRI. Participants then spent the night in the lab with polysomnographic recording. The next day they were given a surprise recognition test.

Results

There was better memory for emotional compared to neutral items in the stress group. Within this group, % of time spent in SWS positively correlated with emotional memory consolidation (r=.37, p=.039). However, SO-SS coupling during SWS was negatively correlated with emotional memory consolidation in the stress group (r=-.47, p=.007). This was driven by participants who showed a high cortisol response following the stressor (cortisol * coupling interaction p=.03) Results were similar when negative and positive items were analyzed separately. No correlations with neutral item memory were found.

Conclusion

Sleep stage time and sleep oscillatory activity exert different effects on emotional memory following stress, and that SO-SS coupling does not always promote episodic memory consolidation. SO-SS coupling can impair emotional memories when encoded during periods of elevated stress, and accompanying neuromodulators such as cortisol are high.

Support

National Science Foundation, Grant/Award Number: BXS-1539361
1082 Offsprings Autistic Behaviors Modify The Relationships Between Maternal Peritraumatic Distress And Sleep Disturbance Following Trauma Exposure
Authors: Chanko N , Williams N , Jean-Louis G , Casimir G , Blanc J
Published: May 2020

Introduction

Neurodevelopmental impairments may alter parents’ sleep and add tremendous stress to their families’ routine. This study examined the relationship between peritraumatic distress, and sleep disturbances among mothers who were exposed to the 2010 Haitian earthquake during pregnancy and whether this relationship is moderated by offspring‘s autistic behaviors.

Methods

Sample includes 361 mother-offspring dyads [mean (SD) age= 27.31 (5.93); 3.1/2(3.88)] who survived the 2010 earthquake in Haiti. Maternal data were collected 3 years following the event via the Earthquake Experience Questionnaire (EEQ), the Peritraumatic Distress Inventory (PDI), and the sleep items of the PTSD Checklist (PCL-S) (such as trouble falling or staying asleep, and repeated disturbed dreams in response to the disaster exposure). Child-related data were obtained from maternal completion of the Echelle d’Evaluation des Comportements Autistiques Revisee (ECAR) (Autistic Behaviors Scale Revised). Pearson Correlations, multilinear regression and interaction effect analyses were conducted to explore the association between peritraumatic distress, offspring’s autistic behaviors and sleep disturbance among the participants.

Results

10.7% of mothers were caught under rubble or were seriously injured during the event. Three years later, 56.83% and 52.9% of them had consequent disturbed sleep and nightmares, respectively. Maternal sleep disturbance correlated positively with peritraumatic distress (r=.38, p=.01) and offspring autistic behaviors (r=.13, p=.05). As hypothesized, adjusting for covariates, peritramatic distress was the strongest predictor of maternal sleep disturbance (B=.310, p<.001). The relationship between maternal peritraumatic distress and sleep disturbance was modified by offspring autistic behaviors (B=.138, p= .015).

Conclusion

This is the first study to document the prolonged effect of peritraumatic distress during the 2010 Haitian earthquake on mother’s sleep disturbance and whether this relationship is moderated by offspring autistic behaviors. The findings support the importance of a sleep component in maternal and child health in disaster preparedness program.

Support

This study was supported by funding from the NIH: T32HL129953
1091 The Effects Of Sleep Duration, Timing, And Depressed Mood On Daily Eating Patterns
Authors: Wescott D L , Dickman K D , Franzen P L , Hasler B P , Roecklein K A
Published: May 2020

Introduction

Insufficient sleep, circadian misalignment, and altered eating patterns are linked to depression. Despite the temporal association between the sleep/wake and feed/fast cycles, it is unclear how depression severity influences this relationship.

Methods

Sixty-eight participants ages 18-65 years across the depression continuum wore an Actiwatch for 5-17 nights and reported daily meal times (730 nights total). Multilevel models tested previous night’s sleep timing and duration as predictors of the length of the next day’s eating window. Within-person sleep duration and timing were entered as Level 1 predictors to account for nightly variation in sleep. Between-person sleep duration and timing were entered as Level 2 predictors. A three-way interaction between depression severity and Level 2 sleep duration/timing was entered. Covariates included age, gender, and day (weeknight/weekend).

Results

Across participants, average later sleep timing predicted a longer eating window (Β= -.222; p =.005). Earlier sleep timing (Β= -.186; p < .001) and shorter sleep duration(Β= -.103; p < .001) relative to a person’s average each predicted a longer next-day eating window. A three-way interaction was found between sleep duration, timing, and depression (Β= -.159; p = .002). At shorter sleep durations, individuals with higher depression severity had a positive relationship between sleep timing and eating window length, and individuals with low depression had a negative relationship between sleep timing and eating window length.

Conclusion

At shorter sleep durations (< 6.5 hr), individuals with high depression and later sleep timing or low depression and early sleep timing had the longest eating windows, which have been linked to adverse metabolic health. Future experiments should test short sleep duration, sleep timing, and depression as potential causes of lengthened eating windows to determine if targeting sleep duration and timing could improve adverse metabolic markers in depression.

Support

NIMH K.A.R. MH103303
1104 Increasing Accessibility of Nightmare Treatment Via Mobile Health
Authors: Speed K J , Nadorff M , Bishop T , Stearns M , Pigeon W
Published: May 2020

Introduction

Nightmares have been tied to a myriad of adverse mental health outcomes and are known to persist after treatment of other concerns such as posttraumatic stress, depression, and anxiety. When reaching clinical levels, nightmare disorder is known to effect 2-6% of the general population, Although many treatments exist for nightmare disorder and posttraumatic nightmares, Imagery Rehearsal Therapy has consistently been cited as the first line treatment. Mobile health (mHealth) technology has emerged as a viable platform from which to deliver sleep medicine interventions.

Methods

We assessed the efficacy of an Imagery Rehearsal Therapy-based mobile application (Dream EZ) developed by the National Center for Telehealth and Technology. College students (n = 99) were recruited in a two-part online study and randomized to the treatment condition or waitlist control. Repeated measures analysis of variance were used to assess the efficacy of smartphone-based mHealth application treatment (Dream EZ) in reduction of psychological symptoms (nightmare distress, PTSD symptoms, and suicide risk) as compared to waitlist control.

Results

Findings support the use of Dream EZ for nightmares distress reduction (main effect: p =.004, d = .57; interaction: p =.049, d = .41). Results regarding effectiveness of Dream EZ in relation to reduction of PTSD symptoms (main effect: p = .415, d = .17; interaction: p =.262, d = .23) showed no significant interactions between PTSD symptoms and treatment group assignment. In relation to changes in suicidality (main effect: p =.007, d = .57; interaction: p =.758, d = .07), findings were nonsignificant.

Conclusion

Use of nightmare-focused treatment through a mHealth smartphone application may be a viable avenue for promoting management of nightmare distress in college students. These findings present an opportunity to explore further options for increasing accessibility of sleep-focused treatment options in a challenging and fast-paced population.

Support

No support to disclose.
1106 Associations Between Severe Mental Illness and Positive Airway Adherence in a Veteran Cohort
Authors: May A M , Gandotra K , Jaskiw G E
Published: May 2020

Introduction

Serious mental illness (SMI) is associated with excess morbidity and mortality irrespective of healthcare access. Adherence differences may contribute to this health disparity. In those with sleep disorders, adherence to positive airway pressure (PAP) can improve health outcomes. We hypothesized that SMI is associated with lower PAP adherence.

Methods

In this retrospective cohort study, 5047 veterans receiving a PAP machine from the VANEOHS (1/1/2010 - 6/31/2015) were evaluated for 90-day PAP adherence (% days used ≥4 hours). A composite variable of any billing diagnosis of psychotic spectrum disorder, bipolar disorder, post-traumatic stress disorder (PTSD), or major depression was examined via linear regression. Analyses were adjusted for demographics, comorbidities, and medications. We conducted sensitivity analyses of 30-day adherence as well as subset analyses of associations between each disorder and adherence.

Results

The group was 38.8 ± 11.9 years old, 3.9% female with 52.6% with major depression, 25.0% with PTSD. 58.4% of the cohort had at least one psychiatric disorder. PTSD with depression was the most common comorbidity in those with two or more psychiatric diagnoses. Unadjusted analyses showed worse adherence in those with any SMI (β = -7.5%, 95% CI: -9.8% -5.3%), which was mitigated in adjusted analyses (β = -1.6%, 95% CI: -5.1%, 1.9%). All individual SMIs were negatively associated with adherence, but only PTSD was associated with less adherence in adjusted analyses (β = -6.4%, 95%CI: -11.2%, -1.6%). Sensitivity analyses of 30-day adherence were similar to primary analyses.

Conclusion

In this large cohort of veterans, broadly defined SMI was associated with lower 30- and 90-day adherence in unadjusted but not adjusted analyses. Replication and refinement of the link between SMI, particularly PTSD, and adherence may provide opportunities for targeted interventions and improve health disparities.

Support

This work was supported in part by Career Development Award IK2CX001882 from the United States (U.S.) Department of Veterans Affairs Clinical Sciences Research and Development Service.

The contents of this work do not represent the views of the Department of Veterans Affairs or the United States government.
1108 Associations Between Insomnia And Anxiety Symptoms: Which Elements Of Insomnia Are Associated With Which Elements Of Anxiety?
Authors: Kapoor A , Perlis M L , Bastien C , Williams N , Hale L , Branas C , Barrett M , Killgore W D , Wills C C , Grandner M A
Published: May 2020

Introduction

It is still not clear which aspects of insomnia are associated with various aspects of anxiety problems. Knowing this could better guide treatment of insomnia comorbid with anxiety.

Methods

Data from the Sleep and Healthy Activity, Diet, Environment, and Socialization (SHADES) study were used, including N=1003 adults age 22-60. All participants completed the Insomnia Severity Index (ISI) and the GAD7 anxiety questionnaire. The ISI was divided into 3 sections, based on prior work: SLEEP symptoms (difficulty sleeping), DAYTIME symptoms (difficulty functioning), and PERCEPTION symptoms (dissatisfaction). GAD7 items included anxiety level, loss of control, worry about many things, difficulty relaxing, restlessness, irritability, and fear. Logistic regression analyses examined each symptom, with each component of the ISI as predictor, as well as age, sex, race/ethnicity and education as covariates.

Results

SLEEP symptoms were independently associated with control (OR=1.09, p=0.03), many worries (OR=1.1, p=0.017), restlessness (OR=1.1, p=0.009), and irritability (OR=1.1, p=0.04). DAYTIME symptoms were independently associated with anxiety level (OR=1.3, p<0.0005), control (OR=1.2, p<0.0005), many worries (OR=1.3, p<0.0005), difficulty relaxing (OR=1.2, p=0.004), restlessness (OR=1.3, p=0.001), and irritability (OR=1.2, p<0.0005). PERCEPTION symptoms were uniquely, independently associated with anxiety level (OR=1.1, p=0.03), control (OR=1.2, p=0.001), many worries (OR=1.2, p=0.001), difficulty relaxing (OR=1.4, p<0.0005), irritability (OR=1.2, p=0.018), and feelings of fear (OR=1.2, p=0.002).

Conclusion

The DAYTIME and PERCEPTION symptoms of insomnia were strongly related to anxiety symptoms. Current treatments for insomnia focus mainly on improving sleep. Future research should test the hypothesis that treating daytime symptoms of insomnia may aid patients with comorbid anxiety.

Support

The SHADES study was funded by R21ES022931. Dr. Grandner is supported by R01MD011600.
1110 Characteristics Of Untreated Sleep Disturbance During Intensive Outpatient Treatment For Substance Use Disorders: Preliminary Results From A Longitudinal Study
Authors: Wilkerson A K , Taylor D J , Sahlem G L , Simmons R O , Russell A , Book S W , Smith J P , Uhde T W , McRae-Clark A L
Published: May 2020

Introduction

Previous studies have shown that sleep problems are commonly reported during treatment for substance use disorders (SUDs) and sleep complaints have been linked to subsequent relapse. However, most of these findings were in well-controlled clinical trials and may not generalize to the public. Little is known about the natural progression of sleep complaints during treatment in community clinics, the most common treatment approach for SUDs. The aim of this study is to longitudinally assess prevalence of clinically significant sleep disturbance at baseline and post-treatment in a community-based intensive outpatient (IOP) SUD treatment program using a multi-method approach with well-validated measures of sleep.

Methods

Adults beginning IOP SUD treatment completed the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Nightmare Disorder index (NDI), and one week of actigraphy and sleep diaries. Measures were repeated following treatment (approximately 5 weeks later).

Results

Preliminary analyses on 21 adults who have been enrolled thus far revealed 85.6% of participants experienced sleep disturbance (PSQI > 5) at baseline. 28.5% of participants reached cutoff for moderate-to-severe insomnia symptoms (ISI > 15) and 42.9% reported nightmares more than once per week. Sleep parameters taken from actigraphy and sleep diaries revealed mean sleep efficiency was 77.5% (TST M = 6.2 hours; TIB M = 7.9 hours). These variables did not improve from baseline to post-treatment. Further, most measures indicated a worsening of sleep, though this did not reach significance (all ps > .05).

Conclusion

This preliminary data show a high prevalence of self-reported sleep complaints and objectively measured poor sleep efficiency that do not improve over the course of treatment. Data collection is ongoing and expected to at least double. More robust analyses, including differences between SUD type (e.g., cannabis vs. opioid) and relationship to relapse at post-treatment, will then be completed.

Support

K12DA031794
1113 Physical Activity Moderates The Sleep-emotional Distress Relationship, But Less So Among Blacks Vs. Whites
Authors: Moore J , Williams N , Chung D , Parra Y , Jean-Louis G , Seixas A
Published: May 2020

Introduction

Emotional distress (ED) is associated with poor sleep. Research shows that minority populations experience greater vulnerabilities to both ED and poor sleep. Interventions such as relaxation training and behavioral therapy address this relationship but are not always successful. Research shows that physical activity (PA) is negatively associated with ED and positively associated with sleep duration. However, it is unclear whether PA attenuates the relationship between ED and sleep, and if this relationship differs by race/ethnicity.

Methods

We analyzed data from the 2005-2015 National Health Interview Survey (NHIS), a nationally representative dataset of 416,152 participants. ED, hours of PA per day, and average sleep duration were collected. Regression models with covariates (age, sex, employment status, BMI) were used to analyze the moderation effect of PA within sleep and ED. Regression models were stratified by race/ethnicity.

Results

261,686 participants (45,926 blacks, 17.55%, and 215,760 whites, 82.45%) responded with the required variables for analysis. 63% of participants reported at least some physical activity. The results of the regression showed that a significant amount of variance in ED stemmed from sleep duration; F (7, 121088) = 1,619.72, p < 0.001. PA was found to have a significant main effect, t(121,088) = 9.01, p= <0.001. There was a significant moderation effect of PA, t(121088) =7.26, p < 0.001. Stratification showed that the moderation effect of PA was not significant among blacks t(121,088) = -1.45, p=0.149 and significant among whites b = -.08, t(101,754) = -7.82, p < 0.001.

Conclusion

The present study found support for moderation of PA in the sleep-ED relationship. However, it found that blacks do not experience the same benefits of PA in this relationship as whites. Further research should be performed to understand the connection of PA to sleep duration and ED.

Support

This study was supported by funding from the NIH: R01MD007716, R01HL142066, R01AG056531, K01HL135452, and K07AG052685
1114 Urbanicity And The Sleep-mental Health Relationship
Authors: Moore J , Seixas A , Casimir G , Nunes J , Matadiaby F , Khosrof A , Jean-Louis G
Published: May 2020

Introduction

Inadequate sleep has been found to be associated with poor mental health. This is especially true in low-income and minority populations, who are concentrated in cities. It is not understood to what degree living in a city vs. a rural environment affects sleep and resulting mental health outcomes. This study seeks to understand how living in an urban environment affects the relationship between inadequate sleep and mental health.

Methods

The study used data from the 2018 US Behavioral Risk Factor Surveillance System (BRFSS,) a nationwide health dataset collected by telephone. Respondents were classified as living in either an urban or rural environment based on their zip code. Respondents reported hours of sleep per night and mental health status. This study classified mental health status based on whether the respondent reported one or more incidences of poor mental health in the previous 30 days.

Results

After filtration, 348,540 respondents were split into urban and rural groups. Binary logistic regression was run in each group to compare how much living in an urban environment contributed to the relationship between sleep duration and mental health. Sleep in the analysis was found to significantly contribute to both models; urban X2(15, N=295,796) = 11,485.70, p <0.001 rural X2(15, N=52,744) = 2,465.64, p <0.001. The estimated odds ratio resulted in a decrease of 13.9% [Exp(B) = 0.861] in reported poor mental health for every unit increase of sleep in the urban population, and decrease of 14.9% [Exp(B) = 0.851] in the rural population.

Conclusion

In urban and rural dwellers, sleep duration predicted poor mental health. Contrary to expectations, sleep was more strongly tied to mental health in rural than urban populations. This was true even after controlling for sex, income, and education level. Further research should seek to understand how environment affects sleep and mental health.

Support

This study was supported by funding from the NIH: R01MD007716, R01HL142066, R01AG056531, K01HL135452, and K07AG052685.
1123 Sleep, Caregiver Burden, and Life Satisfaction in Parkinson’s Disease Caregivers from Mexico and the US
Authors: Perez E , Perrin P B , Lageman S K , Villaseñor T , Dzierzewski J M
Published: May 2020

Introduction

Sleep problems are frequently reported by caregivers of individuals with Parkinson’s disease (PD) and are associated with greater caregiver burden and poorer caregiver life satisfaction. The primary aim of this study was to examine the pattern of associations among PD patient and caregiver sleep problems, caregiver burden, and life satisfaction in PD caregivers. A secondary aim was to assess whether the pattern of associations differed between Mexican and US caregivers.

Methods

Secondary analyses were performed on data obtained from 253 caregivers (age M=59.92, SD=14.66). A composite score was produced for caregiver and patient sleep problems. The Zarit Burden Interview (ZBI) and Satisfaction with Life Scale (SWLS) measured caregiver burden and life satisfaction, respectively. A structural equation model (SEM) was developed to examine the pattern of associations among sleep problems, caregiver burden, and life satisfaction. An invariance design was employed to assess differences in the associations between Mexican and US caregivers.

Results

Fit indices suggested the SEM fit the data adequately. Path coefficients among all variables were significant (p≤.005), except between patient sleep problems and life satisfaction. Three significant indirect effects were found: caregiver sleep problems were negatively associated with life satisfaction via caregiver burden (p=.003); patient sleep problems were positively related to caregiver burden via caregiver sleep problems (p=.005); and life satisfaction via caregiver burden and caregiver sleep problems (p=.002). Despite noninvariance of error terms for the ZBI (z=2.92) and SWLS (z=3.37) between Mexican and US caregivers, the model was generally invariant across countries.

Conclusion

Patient sleep problems were associated with caregiver sleep problems, leading to increased burden in caregivers and poorer life satisfaction. The findings highlight a potential opportunity for empirically-supported sleep interventions in both individuals with PD and their caregivers which may initiate a cascade of salubrious effects on caregiver burden and overall life satisfaction.

Support

Dr. Dzierzewski’s effort on this project was supported in part by the National Institute on Aging (K23AG049955 to J.M.D).
1135 Longer And More Frequent Naps Predict Incident Alzheimer’s Dementia In Community-based Older Adults
Authors: Li P , Gao L , Gaba A , Yu L , Buchman A S , Bennett D A , Hu K , Leng Y
Published: May 2020

Introduction

Excessive napping duration has been associated with cognitive decline. The effect of napping frequency is less understood, and little is known about the development of Alzheimer’s dementia associated with napping. We tested whether longer or more frequent naps in the elderly are linked to the development of incident Alzheimer’s dementia.

Methods

We studied 1,180 older adults (age: 81.0±7.3 [SD]) in the Rush Memory and Aging Project who have been followed for up to 14 years. Motor activities of up to 10 days were recorded at baseline to assess napping characteristics objectively. We defined daytime napping episodes as motor activity segments between 10AM and 7PM with continuous zero-activity for ≥10min but <1h (to avoid off-wrist periods). Segments that were <5min apart were merged. Alzheimer’s dementia diagnosis was determined using the criteria of the National Institute of Neurological and Communicative Disorders and Strone and the Alzheimer’s Disease and Related Disorders Association. Cox proportional hazards models were performed to examine the associations of daily napping duration and frequency with incident AD.

Results

Of 1,180 non-demented participants at baseline (including 264 with mild cognitive impairment), 277 developed Alzheimer’s dementia within 5.74±3.36 years. On average, participants napped for 38.3±1.0 (SE) min and1.56±0.04 (SE) times per day at baseline. After adjustment for age, sex, and education, every 30-min increase in daily napping duration was associated with a 20% increase in the risk of incident AD (95% confidence interval [CI]: 9%-31%; p=0.0002). One more nap per day was associated with a 19% increase in the risk of AD (95% CI: 8%-30%; p=0.0003). These associations remained after further adjustment for total sleep time.

Conclusion

Longer and more frequent daytime naps predict a higher risk of incident Alzheimer’s dementia. Future studies are needed to examine specific underlying mechanisms.

Support

This work was supported by NIH grants RF1AG064312, RF1AG059867, R01AG017917, and R01AG56352.
1136 Polysomnography Is Feasible During Inpatient TBI Rehabilitation
Authors: Drasher-Phillips L , Schwartz D , Ketchum J , O’Connor D , Calero K , Diaz-Sein C , Wharton L , Almeida E , Dahdah M , Bell K , Nakase-Richardson R
Published: May 2020

Introduction

A recent meta-analytic report highlighted that obstructive sleep apnea was 12 times more prevalent in TBI (mixed severity) than in community-based samples. Recent studies highlight prevalent obstructive sleep apnea during acute inpatient rehabilitation which is a time of critical neural repair. Acute sleep disturbances are associated with therapy cooperation due to effects on daytime sleepiness and are associated with key rehabilitation outcomes. Given the high rates of OSA and risk for negative morbidity, this analysis sought to examine the feasibility of administering polysomnography (PSG) with EEG to diagnose sleep apnea during inpatient rehabilitation in persons with moderate to severe TBI.

Methods

This is a secondary analysis from a prospective diagnostic comparative effectiveness clinical trial (NCT03033901) that took place at six NIDILRR and one VA TBI Model System Centers. Participants were included if they met the TBI Model System case definition and slept at least 2 hours per night prior to PSG. PSG was conducted following AASM procedures in the participant’s hospital bed on the inpatient rehabilitation unit. Studies were scored by RPSGT staff and interpreted by a board certified sleep medicine physician at a centralized sleep scoring center in Tampa, FL.

Results

Of 896 potential TBI participants, 449 met initial eligibility and 345 consented for further screening; a final sample of 263 (76%) completed PSG during hospitalization. Primary reasons for not completing PSG included early discharge or medical instability (n=59) and last-minute withdrawal of consent for PSG (n=23). Of the 263 participants who completed PSG, 3 were excluded from analysis due to technical issues and 12 were excluded as the total sleep time (TST) was less than 120 minutes. Of the 248, 85.5% of the PSGs were rated as interpretable/scoreable by RPSGT and sleep physicians.

Conclusion

For a majority of participants, polysomnography is feasible during inpatient rehabilitation. Participants with shorter lengths of stay, medical instability, prolonged agitation may require polysomnography follow-up after discharge.

Support

Supported by PCORI (CER-1511-33005), VA TBIMS, DVBIC with subcontract from GDIT/GDHS (W91YTZ-13-C-0015, HT0014-19-C-0004), and NIDILRR (90DPTB00070, 90DPTB00130100, 90DPTB0008, 90DPT8000402, 90DPTB0001).
1141 Daytime Napping Trajectory Over Time And Its Association With Cognitive Aging: A 13-year Community-based Longitudinal Study Of Older Adults
Authors: Li P , Gao L , Gaba A , Buchman A S , Bennett D A , Hu K , Leng Y
Published: May 2020

Introduction

Daytime napping is common in elderly adults and has been associated with cognitive impairment. Prior studies have assessed napping at one time point, making it difficult to examine the longitudinal progression of napping and its association with cognitive aging. We examined objectively measured daytime napping longitudinally across different stages of Alzheimer’s disease (AD): from no cognitive impairment (NCI), to mild cognitive impairment (MCI), and to Alzheimer’s dementia.

Methods

We studied 1,066 participants (female: 810; age: 81.0±7.3 [SD]) in the Rush Memory and Aging Project who have been followed for up to 13 years. Motor activities of up to 10 days were recorded annually and used to assess napping objectively. We defined daytime napping episodes as segments between 10AM and 7PM with continuous zero-activity for ≥10min but <1h (to avoid off-wrist periods). Segments that were <5min apart were merged. Cognitive and clinical evaluations were administered annually to render a clinical diagnostic classification of NCI, MCI, or Alzheimer’s dementia. To examine how napping duration and frequency change with the progression of AD, we performed linear mixed-effects models with 2 change points anchored at the diagnoses of MCI and AD while adjusted for age, sex, and education.

Results

At baseline, participants had 1.44±0.04 (mean±standard error) naps with an accumulated duration of 35.0±1.1 min per day. Napping duration increased by 5.2±0.3 min and frequency increased by 0.21±0.01 times every year (both p<0.0001). The rate of increase was more than doubled after MCI diagnosis with an annual increase of 11.4±0.7 min in duration and 0.40±0.02 times in frequency (both p<0.0001); these were doubled further after AD diagnosis with an annual change of 26.3±3.1 min in duration and 0.84±0.08 times in frequency (both p<0.0001).

Conclusion

Daytime napping duration and frequency increase with aging, and the increase was accelerated with AD progression.

Support

This work was supported by NIH grants RF1AG064312, RF1AG059867, R01AG017917, and R01AG56352.
1143 Wake-up Stroke In Hispanic Veterans: Clinical Characteristics
Authors: Colon-Feliciano M , Prats N , Sierra-Gonzalez A , Jovet G , Jimenez L
Published: May 2020

Introduction

Wake-up stroke (WUS) is a stroke that occurs during sleep and accounts for 14-29.6% of all acute ischemic stroke (AIS) cases. The use of intravenous alteplase, the therapeutic standard, requires identifying time of stroke onset. Recent studies suggest that obstructive sleep apnea (OSA) is an independent risk factor for WUS. This study aims to describe a population of Puerto Rican Veterans with WUS and to evaluate clinical differences between patients WUS and non-WUS (NWUS).

Methods

The study was a cross-sectional analysis of all patient records with AIS from April 2018 to July 2019. One hundred forty records were reviewed. Patients who woke up with new AIS symptoms were labeled as WUS. Study variables included demographics, comorbidities, medications, sleep disorders, prior stroke, administration of alteplase and the National Institute of Health Stroke Scale (NIHSS).

Results

Among 140 participants predominantly male (98.6%), 27.1% had WUS. The mean age was 75 (range 21-89). NIHSS mean was 5.9. Comorbidities for WUS vs NWUS were as follows: overweight or obese (60% vs 62.6% p=0.667), hypertension (100% vs 95.1% p=0.323), hyperlipidemia (95% vs 93% p=0.999), diabetes mellitus (55.3% vs 67% p=0.212), atrial fibrillation (26.3% vs 24.5% p=0.826), anxiety (36.8% vs 33.3% p=0.697), depression (55.3% vs 51.0% p=0.652), non-smokers (89.% vs 89%), smokers (10.5% vs 11.1%), and prior stroke (34.2% vs 35.3% p=0.905). Insomnia was observed in 42% vs 40% (p= 0.838) and 24% vs 23% (p=0.955) had OSA.

Conclusion

There were no significant differences in clinical characteristics between patients with WUS and NWUS in this sample of Puerto Rican Veterans. OSA was less prevalent than previously reported. Lack of recognition of OSA as a risk factor for stroke and under-diagnosis of OSA might explain the study results.

Support
1144 Actigraphy-defined Sleep And Neurocognitive Decline In Middle-age Hispanic/Latino Adults
Authors: Agudelo C , Tarraf W , Wu B , Wallace D M , Patel S R , Redline S , Daviglus M L , Zee P C , Simonelli G , Levin B E , Mossavar-Rahmani Y , Sotres-Alvarez D , Zeng D , González H M , Ramos A R
Published: May 2020

Introduction

Few studies have evaluated objective sleep measures and longitudinal neurocognitive decline, particularly in middle-age or Hispanic/Latino adults. We evaluated prospective associations between actigraphy-defined sleep and 7-year neurocognitive change among Hispanic/Latino adults. We hypothesized that sleep duration would be associated with neurocognitive decline.

Methods

We analyzed data from 1,036 adults 45-64 years of age from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), a multi-center prospective cohort study of diverse community-dwelling Hispanic/Latino adults. At Visit 1 (2008-2011), participants underwent neurocognitive assessments, 7-days of actigraphy, home sleep testing, and sleep questionnaires (including the Insomnia Severity Index). Seven years later, participants repeated neurocognitive assessments. The neurocognitive battery included the Six-Item Screener, Brief Spanish-English Verbal Learning Test, phonemic word fluency test, and Digit Symbol Subtest. Survey linear regression was used to evaluate prospective associations between actigraphy-defined or self-reported sleep variables and neurocognitive change. Final models adjusted for objectively-defined variables (age, body-mass index, Field Center, and time between neurocognitive assessments), and self-reported variables (sex, education, Hispanic/Latino background, alcohol consumption, physical activity, heart failure, cerebrovascular events, depression and anxiety symptoms, and antidepressant use).

Results

At Visit 1, the sample was 55% female and mean age was 54.9±2.2 years. The mean sleep duration was 402.6±27.6 minutes, mean sleep-onset latency was 11.3±9.7 minutes, mean number of days with naps of ≥ 15 minutes duration was 1.1±0.7, and mean sleep-time per nap was 51±14.1 minutes. Increased sleep-onset latency was associated with 7-year declines in global neurocognitive function (β=-0.0026, p<0.01), verbal learning (β=-0.0028, p<0.001) and verbal memory (β=-0.036, p<0.05). Increased sleep-time per nap predicted better verbal memory (β=0.0038, p<0.05). In contrast, sleep duration, sleep fragmentation, and self-reported sleep measures were not associated with neurocognitive change.

Conclusion

Among middle-age adults, sleep-onset latency and nap duration were associated with neurocognitive change. These findings may serve as targets for intervention of neurocognitive decline.

Support

This work is supported by the National Institute on Aging: R01AG048642, RF1AG054548, R01AG061022, R21AG056952, and R21HL140437 (AR).
1148 Conceiving A Connected, Preventative Treatment Stance Across The Brain-gut-microbiota Axis In Prodromal Parkinson’s Disease: The Power Of Preventative Sleep Health
Authors: Chandler J F , Bullock M M , Chandler N G , Nelson S M , Hoyle S P , Guice J O
Published: May 2020

Introduction

Early non-motor symptoms of Parkinson’s Disease (PD) include sleep and digestive disturbances that share a common pathology via alpha-synuclein (AS) deposition in the central nervous system (CNS) and formation in the enteric (ENS). The concept of prodromal PD as expressed by the brain-gut-microbiota axis continues to gain credibility across multiple literatures; yet, no unified treatment plan has been suggested. Disconnected, symptomatic treatment of prodromal PD may unintentionally hasten its development via compromise of REM sleep quality and reciprocal gut health. A more connected, comprehensive approach is needed. We conducted a systematic literature review to hypothesize next steps in treatment research for prodromal PD.

Methods

A systematic literature review using the Boolean combinations of “ALPHA-SYNUCLEIN” & - “SLEEP”, “GUT MICROBIOME”, and “EXERCISE” in all fields, restricted to the last 5 years, focusing on specification of prodromal PD, was conducted. Results were combined with an examination of current treatment practices in PD.

Results

38 articles met inclusion criteria. Results were categorized through a presupposed primacy of sleep.

Conclusion

Due to the emerging nature of the prodromal PD idea, current treatment practice is myopic and may contribute to the progression of PD. Specifically, 1) sedative-hypnotic sleep interventions suppress REM, where clearing of CNS alpha-synuclein occurs, and 2) proton-pump inhibitors (PPI) cause significant gut dysbiosis, which may contribute to initial AS misfolding in the gut. Early identification of prodromal PD symptoms via cross-referenced clinical interview may allow for early behavioral interventions that underlie healthy brain-gut-microbiota axis functioning. Results outline specific measures that may slow PD-related synucleinopothies. The highest impact practices in this regard are REM-focused sleep hygiene and cardiovascular conditioning in a reciprocal relationship, highlighting the necessity of an early-intervention, preventative health model for conquering PD.

Support

This work was made possible in part by a donation from Drs. Shane Pitts and Michelle Hilgeman in support of Birmingham-Southern College’s Southern Sleep Laboratory.
1160 Improved Daytime Sleepiness Following Daily Morning Blue Light Therapy Is Associated With Altered Resting-state Network Connectivity
Authors: Raikes A C , Dailey N S , Vanuk J R , Alkozei A , Grandner M A , Killgore W D
Published: May 2020

Introduction

Light exposure, particularly blue wavelength light, has consistent positive effects on daytime sleepiness following mild traumatic brain injuries (mTBIs). While self-perceived improvements in daytime sleepiness are well-documented, the neurobiological underpinnings are not well understood. The purpose of this study was to localize changes in functional connectivity after daily morning blue light therapy (BLT) and to associate these changes with improvements in post-mTBI daytime sleepiness.

Methods

29 individuals with a history of mTBI were randomized to receive either BLT (n=13) or placebo amber light (ALT; n=16). All participants self-reported daytime sleepiness (Epworth Sleepiness Scale (ESS); lower is better) and underwent resting-state functional magnetic resonance imaging at pre- and post-treatment. Whole-brain functional connectivity (FC) was estimated as the correlations between 400 cortical regions of interest (ROIs) assigned to 7 resting-state networks. A two-sample T-test for post-treatment ROI-to-ROI FC identified target connections (FDR corrected p<0.01). Post-treatment ESS scores and FC for these connections were correlated for treatment-related brain-behavior associations (uncorrected p<0.05).

Results

Lower FC after BLT in 4 ROI-to-ROI connections linking the default mode and visual networks was associated with lower ESS scores. Higher FC after BLT in 9 ROI-to-ROI connections linking attention, cognitive control, and visual networks was also associated with lower ESS scores.

Conclusion

BLT resulted in decreased self-reported daytime sleepiness, which was associated with decoupling of the default mode and visual networks as well as increased connectivity between and within attention and cognitive control networks, suggesting potentially improved attention to relevant stimuli and cognitive processes and less internal mentation. These associations may contribute to improved alertness, attention, and cognitive performance following a mTBI. Further work is needed to identify the optimal timing and dosage of BLT to maximize these outcomes.

Support

This study was funded by an award to Dr. Killgore from the US Army Medical Research and Materiel Command (USAMRMC; award number: W81XWH-14-1-0571).
1164 Prospective Associations Between Sleep Duration, Variability and Timing and Diseases from an Electronic Health Record Biobank in 24,065 Individuals
Authors: Dashti H S , Cade B , Stutaite G , Saxena R , Redline S , Karlson E
Published: May 2020

Introduction

Implementation of electronic health records (EHR) across healthcare systems linking clinical to survey data has enabled systematic assessments of longitudinal relationships between sleep traits and diseases classified by PheWAS codes where ICD-9/10 codes are collapsed to categories based on clinical similarity. In the Partners Biobank, a hospital-based virtual cohort from Mass General Brigham in greater Boston, MA, we aimed to assess associations between sleep traits and incident diseases.

Methods

Self-reported weekday/weekend bed and wake times from a survey at consent were used to derive sleep traits. Incident diseases were defined as two incident PheWAS codes on separate dates ≥1y after consent. Cox proportional hazards models compared short (<7h) and long (≥9h) sleep duration, with 7-8h (referent group), adjusted for age, gender, race/ethnicity, and employment status, then further adjusted for BMI. Similarly, sleep midpoint (midpoint between weekend wake/bed times), sleep debt (difference in weekend/weekday sleep duration), and social jetlag (difference in weekend/weekday sleep midpoint) were assessed.

Results

The analytical sample consisted of 24,065 adults (mean sleep duration =8.12h) seeking regular care with sleep data. Participants had a total of 7,513,649 ICD codes of which incident 323,946 ICD codes mapped to 137,137 PheWAS codes. Over a median follow-up of 2.73 years (interquartile range: 1.82-3.98), participants sleeping <7h had a significantly higher risk of incident Acute pain [hazard ratio(95% confidence interval)=1.46(1.2-1.78)], Tobacco use disorder [1.42(1.18-1.71)], Sciatica [1.72(1.3-2.27)], and Edema [1.69(1.25-2.28)]. Each additional hour of later sleep midpoint and increased sleep debt and social jetlag associated with higher risk of incident Major depressive disorder [midpoint:1.30(1.14-1.49); debt:1.23(1.09-1.38); jetlag:1.54(1.27-1.84)]. Associations retained significance upon further adjustment for BMI, except for Edema, and no other associations were observed at the Bonferroni threshold (P=0.0125).

Conclusion

Our findings in a large hospital-based virtual cohort support unique inter-relationships between sleep duration/timing on somatic, behavioral, and mental health outcomes.

Support

H.S.D. and R.S. are supported by NIDDK grant R01DK107859. B.C. is supported by K01-HL135405-01. S.R. and R.S. are partially supported by R35 NHLBI HL 135816.